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Sunday, Aug. 17th 2014

That first family meeting when you don’t have a plan

The long term care time bomb- the family meeting

In my last article I briefly touched on the financial and emotional impacts when a family member requires long-term care. The best way to defuse the long-term care time bomb and ensure that mom and dad continue to live in independence is to have a plan. However for this article, we’re going to assume that mom and dad do not have a plan. They have no long term care insurance. They are both in their mid-80s. Mom has dementia and dad was her primary caregiver. Dad has just fallen and broken his and now they both require care. What do we do?

The siblings meet to discuss how they can help mom and dad. Like most seniors, mom and dad want to stay home. Mom and dad have saved over $250,000 but the siblings realize that a few years in assisted living or a nursing home would spend down all these dollars. So, they decide that the family will provide the care. Initially everyone has good intentions but in reality, providing care will fall primarily on the sibling(s) who live closest to mom and dad. In this case it’s a daughter and she is also raising a grandchild. It won’t take long before she starts to feel overwhelmed. In many cases the emotional and physical strain of trying to work and be the primary caregiver for a family member can have a negative impact on the health of the care giver.

Step 1 – Get the Power of attorney straight. Mom has dementia and dad is in the hospital. The first thing that the siblings need to do is to ensure one of the siblings have power of attorney authority for both the finances and medical care for their parents. This assumes that dad cannot, at least for the time being. This could be an article by itself so I will just say consult with an attorney.

Step 2 – Consider additional Resources. At the family meeting, the siblings will feel overwhelmed and not be sure where to turn. In November of last year I wrote an article about programs available to seniors. For brevity sake, I won’t go into all the details now. In this case, the family should contact the Kansas Aging and Disability Resource Center (ADRC). Their website is at www.ksadrc.org and their toll-free number is 855-200-2372. They are a centralized resource center which provides information and referral services for older adults and persons with disabilities. A local resource is the Leavenworth Council on Aging. This is a county agency that provides services to any person age 60 or older. For a full listing of their services go to www.leavenworthcounty.org/home.asp.

Step 3 – Develop a plan of care and include relief or respite care. Once the family determines what resources are available to help, they can finish their plan of care. Let’s assume that the siblings come up with a plan where they all take on a share of mom and dad’s care. Let’s also assume that to the maximum extant possible, they include input from mom and dad. They know they are all going to need a break every now and again so they plan on brining in additional care givers to provide respite or relief for the primary care givers. They can hire an individual or they can hire an agency. An agency has some advantages. They should be licensed with bonded care givers (that means they are insured). They should also have more than one care giver oriented to the case so they can respond on short notice with more than one care giver available to staff the case. Most importantly, the agency should have done a detailed background check and drug screening. You can’t be too careful these days regarding who is coming into your home. Once the paperwork is signed, the agency can be your on-call back up. This is especially important should either mom or dad take a turn for the worse and need more care than the family can provide on short notice. The agency should be flexible enough to provide care that ranges from 24 hrs/7 days/week to just a couple of hours every other week or so.

Step 4 – have a financial plan. Assuming dad is no longer fully capable of handling the details of family finances; a trustworthy sibling or power of attorney must assist in developing a plan. This plan outlines an orderly spend down of assets. Once all of mom and dad’s assets are spent; then the plan should assume a transition to Medicaid. In addition to savings and investments, an asset often overlooked is the equity in the home. If mom and dad have a home that is paid for or nearly paid for, they can access that equity to help pay for their care. A reverse mortgage or home equity line of credit (HELOC) are two tools that they can use. I wrote an article about reverse mortgages in March of this year. If the family does not use the equity in the home and applies for Medicaid when they qualify, the state may put a lien on the home anyway. The state would recoup some of the money it spends on mom and dad when the second spouse passes away and the home is sold. See my article on the Kansas Partnership Program from February 2013.


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