Let’s face it. It’s never easy to discuss elder issues with aging parents or older persons we know or love. Whether it’s a parent, a relative, friend or even a neighbor, talking about when it’s time to get help due to the aging or disease process is never easy.

But, what if we all decided to get proactive and start talking to our aging loved ones BEFORE they show their age or are just too old or ill to listen! What if we were to actually talk to the ones we know and love about long term health and future well being.. intentionally? One of my professional goals as a board certified geriatric care manager is to educate peers and the public at large on why preparing for the care of an aging loved one (or yourself- all of you baby boomers!) is not only wise, but it’s very practical, while offering a peace of mind that no amount of money or time can buy!

The short answer is, just do it, talk! That’s right, have the talk, already. There is no easy way or step by step-proven method. It just takes love and time and focusing on the aging love one’s future needs, or your own if you get wise and start your own long term care funding. According to The Gerontological Society of America, we need to “recognize the tendency to stereotype older adults…” and “avoid speech that might seen as patronizing…” Just do it. Face-to-face, with your parents, or whoever, and at a set time, with poise and grace and all of the confidence you have in the research you have done on long term care. Yes, do some more research, please! Ask aging loved ones if they have a plan, or what are their end of life wishes to get the conservation going. Doing a P.O.S.T. form is always a great way to start the plans for everyone in the family, so it seems as if it’s a family affair. End of life advanced directives is just a starting point, so remember to get back on track of discussing long term care wishes as well, and include long term care plans there, or in a living will, etc. Here is where to get your P.O.S.T. forms, by the way, and don’t forget to get you primary care physician to sign it after you have fully understood it:

Click to access Post_Form.pdf

First of all, let’s compare what talking to our older loved ones ahead of time looks like, versus at time of aging event. When we schedule a time to sit with older persons (before middle to late stage dementia or severe latter stages of chronic illness- if at all possible) while they are able to think/speak freely and clearly, we have to find out what their resources are anticipated to be. Aging persons need to be “competent’ when discussing their long term care or health care wishes. We can discuss power of health care in later blogs…
Here is a good article for additional details about having the long term care “talk!”
https://www.caring.com/caregivers/starting-the-conversation/

Don’t wait until it’s too late! Planning ahead for the cost of care, and where the care will be, all depends on the resources. Think ahead before having any conservation involving long term care (health and well being) planning about where do you think the resources are for your family:

1. Family will have/give of time and resources when time comes
2. Savings, real estate, investments, funds, retirement
3. Veteran’s benefits
4. Medicaid
5. Luck or Fortune

Once it is established and understood by family or potential caregivers that Medicare DOES NOT pay for retirement homes, independent living places, group homes, assisted living facilities or “custodial care,” it’s time to assess what benefits may be available in the future such as long term care insurance, veteran’s benefits, savings or other care-giving resources.

It’s also good to bear in mind that Medicaid for seniors is entitlement based and reserved for indigent persons who do not have any resources, or who have run out of resources and need nursing home level of care, determined by functional and medical status, based on activities of daily living; which is also referred to as “A.D.L.’s.” Or, at least, that is why Medicaid started, as “aide” to the poor elderly population, in the first place.

Planning ahead reminds me of what women occasionally do when wanting a ridiculously expensive pair of shoes, or what anyone would do when car shopping- in that it must be determined, how much is in hand, or, in other words, how far will the money go? What can our resources buy? And that’s how it is in the senior care market when prospecting when and where we can afford a place to age. Currently, most assisted living facilities range from $2,500.00 upwards to $10,000.00 monthly depending on the locale and level of care, etc. There are typically added costs. That’s why, when you start doing the math, it’s easy to see that grandpa’s $200.00 life savings will only last three years if the place he chooses to “age in place” is expected to cost, let’s say, around $5,500.00 each month. I always advise families to recheck their long insurance policies to see what the max time or max benefit is in years, since so many are for only four years max, no matter how long the premiums were paid. As the article above describes, the longer you wait to plan ahead, the more likely you will care for your parents in your home! And there is nothing wrong with that at all, since this issue is very personal to each family, in fact, and should be more family driven I think-

Anticipating how far and how wide the resources can go is probably why many caregivers choose to take care of a loved one at home though, seeing that there is not really an “in between place…” Meaning, that there is hospital care (acute care) or “rehab,” in a nursing home (sub-acute care); and only then, if there were three consecutive in-patient stay mid-nights at the hospital, in order to be eligible for “rehab,” on Medicare’s “up-to 100-days…” dime! BTW: Medicare pays 100% for first twenty days only and 80% from day twenty-one through day one hundred- if “progress” is reported! Find out more at:
https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care

Families pay premiums for years on a long term care health plan that they will hopefully outlive, or depend on investments, pensions and/or other funds that will eventually run out. Some families set up set aside trust funds for their care, and then there are those families that know their resources lie in the family itself; they know that their loved ones will care for them as initiated by a living will and/or advance directives requesting end of life be at home. Worse yet, is in the case

It just makes sense to get educated on what Medicare DOES NOT pay for, and figure out that older Americans who do not have a farm to sell, a home to get equity from, or a hefty 401K, end up on the waiting list for Medicaid facilities. Yes, waiting list. Most facilities for indigent elder Americans unable to care for themselves, must wait until a bed becomes available. And this alarming statistic is not getting any better!

So far, we have discussed planning ahead, or getting somewhat of a plan in place for the first 3-5 years of aging in place. Setting up set aside trusts are always most economical and ensure that veteran’s benefits and/or Medicaid benefits will be easier to apply for when actual taxable income is at poverty levels for long term care facility placement in Medicaid facility. It’s not a bad idea to go on a tour of such places now, just to see what they are like, if you do not know-

What about when our aging loved ones are showing their age and a medical event has occurred or is certainly going to soon enough, and there’s no plan? You are not alone. This is the case with most folks now-a-days. It’s no matter the cause, even though economically, no one is free from the cost of living or death…

In most cases, we are taking care of our loved ones at home until we just can’t. And when we can’t, we find ways to lower our incomes through the help of elder law attorneys who do so at cost to the estate! In any case, that’s why as a former hospital discharge planner, I would advise families that the time has come to start looking at the Medicaid facilities in their communities since after the hospital and “rehab” or home-health, which is not 24/7 care, they would have to care for their loved one. And in such cases, where there is severe chronic disease, or stroke or dementia, this is a hardship for some spouses, who are showing their own ages, or for some families and having a backup plan is advised. Knowing what assisted living facilities offer respite care for aging loved ones needing moderate assist for activities of daily living is always a good idea!

There is so much to do when an elderly loved ones start really showing their age in the advanced years, and by simply having a plan ahead, helps when the time comes and the family knows what steps to make to ensure quality of care at the right time, and at the right place, and with the right resources. If your loved one is showing their advanced age and incur a medical event, always ask to speak to the hospital social worker about long term care options in your community. Also, there are so many organizations that can help:

Area Agencies on Aging 1-800-677-1116

S.H.I.P. (State Health Ins. Program) 1-877-801-0044

National Council on Aging 1-800-373-4906

Senior Citizens, Inc. (Nashville Office) 615-743-3400

Gerontological Society of America 1-202-842-1275

https://fivewishes.org/shop/order/product/five-wishes

Meanwhile, I will keep doing research on what people are doing about talking with their aging loved ones (or for themselves) about their long term care wishes!Don’t let your older loved ones start showing their advanced age before you ask them where they prefer to age in place, and if plans change and you find you have to place them in a facility down the road, just know, you are not alone. We are all human, and if we do the best we can, than leave it at that. Things change and stuff happens. As much as we all like to be in control, we are not. God is.

Find out more at
https://www.medicare.gov/what-medicare-covers/what-part-a-covers/what-are-my-other-long-term-care-choices