Forefield Caring for Your Aging Parents

Miles B. Kessler, CFP®Investment Representative

870 Kipling StreetSuite A

Lakewood, CO 80215-5826Direct: 303-290-8942

Branch: [email protected]

Caring for Your Aging Parents

January 28, 2016Page 1 of 8, see disclaimer on final page

Caring for Your Aging ParentsCaring for your aging parents is somethingyou hope you can handle when the timecomes, but it's the last thing you want to thinkabout. Whether the time is now or somewheredown the road, there are steps that you cantake to make your life (and theirs) a littleeasier. Some people live their entire lives withlittle or no assistance from family and friends,but today Americans are living longer thanever before. It's always better to be prepared.

Mom? Dad? We need to talk

The first step you need to take is talking toyour parents. Find out what their needs andwishes are. In some cases, however, theymay be unwilling or unable to talk about theirfuture. This can happen for a number ofreasons, including:

• Incapacity• Fear of becoming dependent• Resentment toward you for interfering• Reluctance to burden you with their

problems

If such is the case with your parents, you mayneed to do as much planning as you canwithout them. If their safety or health is indanger, however, you may need to step in ascaregiver. The bottom line is that you need tohave a plan. If you're nervous about talking toyour parents, make a list of topics that youneed to discuss. That way, you'll be less likelyto forget anything. Here are some things thatyou may need to talk about:

• Long-term care insurance: Do they have it?If not, should they buy it?

• Living arrangements: Can they still livealone, or is it time to explore other options?

• Medical care decisions: What are theirwishes, and who will carry them out?

• Financial planning: How can you protecttheir assets?

• Estate planning: Do they have all of thenecessary documents (e.g., wills, trusts)?

• Expectations: What do you expect fromyour parents, and what do they expect fromyou?

Preparing a personal datarecord

Once you've opened the lines ofcommunication, your next step is to prepare apersonal data record. This document listsinformation that you might need in case your

parents become incapacitated or die. Here'ssome information that should be included:

• Financial information: Bank accounts,investment accounts, real estate holdings

• Legal information: Wills, durable power ofattorneys, health-care directives

• Funeral and burial plans: Prepaymentinformation, final wishes

• Medical information: Health-care providers,medication, medical history

• Insurance information: Policy numbers,company names

• Advisor information: Names and phonenumbers of any professional serviceproviders

• Location of other important records: Keysto safe-deposit boxes, real estate deeds

Be sure to write down the location ofdocuments and any relevant accountnumbers. It's a good idea to make copies of allof the documents you've gathered and keepthem in a safe place. This is especiallyimportant if you live far away, because you'llwant the information readily available in theevent of an emergency.

Where will your parents live?

If your parents are like many older folks,where they live will depend on how healthythey are. As your parents grow older, theirhealth may deteriorate so much that they canno longer live on their own. At this point, youmay need to find them in-home health care orhealth care within a retirement community ornursing home. Or, you may insist that theycome to live with you. If money is an issue,moving in with you may be the best (or only)option, but you'll want to give this decisionserious thought. This decision will impact yourentire family, so talk about it as a family first. Alot of help is out there, including friends andextended family. Don't be afraid to ask.

Evaluating your parents'abilities

If you're concerned about your parents' mentalor physical capabilities, ask their doctor(s) torecommend a facility for a geriatricassessment. These assessments can be doneat hospitals or clinics. The evaluationdetermines your parents' capabilities forday-to-day activities (e.g., cooking,housework, personal hygiene, takingmedications, making phone calls). The facility

The first step you need totake is talking to yourparents. Find out what theirneeds and wishes are.

Don't try to care for yourparents alone. Many localand national caregiversupport groups andcommunity services areavailable to help you copewith caring for your agingparents.

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can then refer you and your parents toorganizations that provide support.

If you can't be there to care for your parents,or if you just need some guidance to overseeyour parents' care, a geriatric care manager(GCM) can also help. Typically, GCMs arenurses or social workers with experience ingeriatric care. They can assess your parents'ability to live on their own, coordinateround-the-clock care if necessary, orrecommend home health care and otheragencies that can help your parents remainindependent.

Get support and advice

Don't try to care for your parents alone. Manylocal and national caregiver support groupsand community services are available to helpyou cope with caring for your aging parents. Ifyou don't know where to find help, contactyour state's department of eldercare services.

• Caregiver support groups and training• Adult day care• Respite care• Guidelines on how to choose a nursing

home• Free or low-cost legal advice

Once you've gathered all of the necessaryinformation, you may find some gaps. Perhapsyour mother doesn't have a health-caredirective, or her will is outdated. You may wishto consult an attorney or other financialprofessional whose advice both you and yourparents can trust.

Or, call (800) 677-1116 to reach the EldercareLocator, an information and referral servicesponsored by the federal government that candirect you to resources available nationally orin your area. Some of the services available inyour community may include:

Tips for Caregivers• Post important telephone numbers in case

of emergency (e.g., physician, emergencyservices).

• Safeguard your parent's home.• Complete first-aid and CPR courses.• Talk to your parent about the future;

understand his or her wishes.• Make sure your parent has a will, durable

power of attorney, health-care proxy, andliving will.

• Join a support group or cultivatefriendships where you can talk openlyabout your caregiving responsibilities andchallenges.

• Seek assistance from friends and relatives,community services (home health care,meal delivery, adult day care, etc.), andother sources.

• Talk to your employer. Some employerswill help by offering flexible schedules orother assistance.

• Be aware that the Family and MedicalLeave Act requires employers of 50 ormore employees to grant eligibleemployees unpaid leave to care for amember of their immediate family who hasa serious health condition.

Ways to safeguard the home

Install an emergency alertsystem that can be activatedfrom anywhere in the home.

Install grab bars and handrails,place nonslip strips in tubs andshowers.

Secure or remove rugs, keeppaths clear, and make surelighting is adequate to preventfalls.


Housing Options for Aging Parents

In-Home Care Assisted-LivingFacility

Nursing Home

When to consider Parent can liveindependently butneeds someassistance

Parent can liveindependently butneeds someassistance

Parent can't liveindependently andrequires regularnursing care

Types of careprovided

• Medical care(nursing or healthaide)

• Household help• Companion or

caretaker services• Meal delivery• Transportation

• Rental rooms,apartments, orhouses

• Housekeepingservices

• Meals• Social activities• Transportation• May provide limited

health-careservices

• 24-hour access tomedical care

• Custodial care:some help eating,bathing, dressing,or takingmedications

• Skilled nursing care

Potential advantages • Can remain infamiliarsurroundings

• May be lessexpensive thanassisted-living ornursing home careif limited servicesare needed

• Staff available 24hours a day

• Social interactionwith other residents

• May havehome-likeatmosphere

• Social interactionwith other residents

• Access toround-the-clockmedical care

• May have specialcare units forindividuals withAlzheimer's diseaseor relatedconditions

Potentialdisadvantages

• Strangers in home• Can be difficult to

coordinate care

• Limited privacy• Long waiting lists• High fees for extra

services

• Limited privacy• Long waiting lists• Very expensive

What you need to do • Assess hazardsand functionality ofhome, renovate ifnecessary

• Check credentialsof agency orindividual providingservice

• Research facilitythoroughly

• Consult an attorneybefore signing acontract

• Research facilitythoroughly

• Consult an attorneybefore signing acontract


Medicare, Medigap, and Medicaid

Medicare Medigap Medicaid

What is it? Federal healthinsurance program forSocial Securityrecipients. Parts A andB comprise the originalMedicare program.Medicare Advantage(also referred to asPart C) plans are alsoavailable in someareas. They providemanaged care andfee-for-service optionsthrough privateinsurers.

Medicare supplementinsurance issued byprivate companies.Typically, individualswho have MedicareAdvantage would notneed a Medigap plan.

Joint federal-stateneed-based healthinsurance program.Eligibility requirementsand covered servicesvary from state tostate.

What does it cover? All or some portion of:Part A: Hospital andskilled nursingfacilities, home healthagency care, hospicecare, inpatientpsychiatric care, andblood transfusions.Part B: Doctors,outpatient mentalhealth services,therapy, part-timeskilled home healthcare, certainpreventative services,and other medicalservices.Part C: All the benefitsoffered by the originalMedicare plan. Someoffer added benefitssuch as prescriptiondrugs, eye exams, andhearing aids.Part D: Prescriptiondrug coverage(optional).

All or some portion of:Medical care notcovered by Medicare,deductibles,co-payments, andcoinsurance; plansmay also cover otherservices such as eyeand dental exams.

All or some portion of:A broad range ofmedical servicesincluding inpatient andoutpatient hospitalcare, prescriptiondrugs, nursing homecare, and skilled care.

Who is eligible? Generally, personsage 65 or older, andthose with certaindisabilities or diseasesare eligible forMedicare Parts A andB.Anyone eligible forParts A and B iseligible for Part C andPart D.

Individuals who areenrolled in MedicareParts A and B.

Individuals who havelimited income andresources and whomeet other eligibilityrequirements.


What is the premiumcost in 2016?

Part A: Mostbeneficiaries don't payfor this coveragebecause of prior SocialSecurity coveredemployment.Part B: Mostbeneficiaries willcontinue to pay$104.90, the samepremium as in 2015.Others will pay thestandard premium of$121.80 or a higherpremium, dependingon income.Part C: Varies byinsurer, state, andplan.Part D: Varies byinsurer, state, andplan.

Premiums vary bycompany, region, andplan. There aregenerally 10 availableplans, each offeringdifferent levels ofcoverage. Not all plansare available in everystate.

No premium.

What does it take toenroll?

If you are receivingSocial Security orRailroad Retirementbenefits (or areapplying for benefits)at or prior to age 65,you will beautomatically enrolledin Part A and Part B.Contact the SocialSecurity Administrationto enroll if:• You will not receive

Social Security orRailroad Retirementbenefits at age 65

• You want to enrollin Medicare Part C

• You want to applyfor benefits prior toage 65 due to acovered medicalcondition

Purchase a policy froman insurancecompany.You can findinformation onMedigap policiesoffered in your area byvisiting the Medicarewebsite or calling(800) 633-4227.

Application proceduresvary from state tostate.For information,contact the agencyresponsible foradministering Medicaidin your state.

Medicaid eligibility rules arecomplicated and differ fromstate to state. It's importantto get the advice of anexperienced Medicaidplanning professional beforeapplying for benefits.


Common Incapacity Documents

Durable Power of Attorney for Health Care (DPAHC)/Health-Care Proxy

Advantages Disadvantages

• Is flexible--allows your representative to acton your behalf and make medical decisionsbased on current circumstances

• Generally, your representative can makeany decision you would be allowed to make

• Generally can be used any time youbecome incompetent

• Not practical in an emergency--yourrepresentative must be present to act onyour behalf

• Not permitted in some states

Living Will


• Allows you to convey decisions regardingyour medical care without relying on anyone person to carry out your wishes

• Generally can be used only if you areterminally ill or injured, or in a persistentvegetative state

• Generally used only to make decisionsregarding life-sustaining treatments

• Emergency medical personnel generallycannot withhold emergency care based on aliving will


Do Not Resuscitate (DNR) Order


• Allows you to decline CPR if your heart orbreathing fails

• Effective in an emergency--your doctorshould note an in-hospital DNR order onyour chart. Out-of-hospital DNR orders takevarious forms, depending on the laws ofyour state. ID bracelets, MedicAlert®necklaces, and wallet cards are somemethods of noting DNR status.

• Some states allow DNR orders only forhospitalized patients--others do not restricteligibility

• Only used to decline CPR in case of cardiacor respiratory arrest


Durable Power of Attorney (DPOA)


• You control who acts and what they can dowith your property

• Low cost to implement• Decreases the chance of court intervention

• Some states do not permit a "springing"DPOA (i.e., a DPOA that is effective onlyafter you have become incapacitated)


Miles B. Kessler, CFP®Investment Representative

870 Kipling StreetSuite A

Lakewood, CO 80215-5826Direct: 303-290-8942

Branch: [email protected]

January 28, 2016Prepared by Broadridge Investor Communication Solutions, Inc. Copyright 2016

Specializing in benefits and retirement strategies for Federal employees.Personalized financial services designed to meet your individual needs and objectives.

Securities and investment advisory services offered through Royal Alliance Associates, Inc., memberFINRA/SIPC and a registered investment advisor. Insurance services offered through Kessler & Associates,Inc., which is not affiliated with Royal Alliance Associates, Inc.

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