The Golden Years Having “The Talk” with your parents.
Aging in and of itself can be challenging, but when you add costly medical expenses and additional care into the equation, many families reach an emotional and financial breaking point. While watching a parent or loved one on the decline can be inevitably stressful, there are things that you can do to make the process easier to handle for everyone.
This article details the personal experience and recommendations of Barbara Zook, Tricky Bills Resident Billing Expert based on her experience caring for her aging parents.
My mom is 92 in a couple days. I’m lucky that she is healthy and lives a full active life with my younger sister, and her daily healthcare expenses are minimal. My dad not have this same experience. He was diagnosed with a slow form of dementia that took years to progress. The last 2 years he was alive caused an intense and stressful time for both of my parents. In this article, we’ll provide some tips about how to approach a difficult medical situation when a loved one is on the decline; including, what you need to prepare and think about to make these times easier.
Many of us have older parents who rely on us to understand all of the financial implications of medical procedures including the “insurance stuff” and “pre-certification, authorization requirements so that they can focus on getting the appropriate tests done for diagnosis and treatment.
We often hear stories from family members who have an aging parent that falls or injures themselves. These stories tend to sound a bit like, Mom broke her hip and had to have surgery. She stayed within inpatient care for a couple of days and was then transferred to a rehab facility. At rehab, she had physical therapy and some occupational therapy with the expectation that she would return home, but during rehab she developed further complications... In the end, we had to find a nursing home, or arrange for permanent care situation as her health was on the decline, etc." If this sounds familiar, you are certainly not alone! There are things we can do while family members are healthy that will make it easier to support them in a medical emergency.
Let’s look at a few must do’s once our parents reach Medicare age. This article is the first of a two part series and starts with broad and more general tasks. The next article will address how to manage the specific emergency from a financial perspective.
You need to sit down and have “The Talk”. We all hate having the talk, and they most likely will blow you off but keep trying every few months. The conversation may be difficult but this will set you up should you need to get a power of attorney or answer tough questions from medical practitioners.
General Access & Power Of Attorney
Should something happen you will need access to ID's and passwords to their accounts, email, credit cards etc. They don’t need to hand you a list right then and there, but it needs to be completed and given to their attorney to hold for the eventful day you need them. The list needs to be updated yearly. You can also put it into a safety deposit box as long as you are listed on the ownership on the safety deposit box. Some documents to think about.
Pension documents
Stocks and bonds
Business operating agreements for LLC, or partnership operating agreements
Property deeds and titles
Loans, debt and to whom, and account numbers
Savings bonds
Copy of their Will,
Power of attorney (POA) so you can, in an emergency, be able to handle decision making aspects of their lives. There are different types of POA. Request a meeting with mom, dad, and their attorney to discuss at length what type of POA would be the most beneficial. It should include the ability to make the decisions related to their healthcare such as obtaining medical records, talking to doctors, talking to insurance companies. It’s also important to consider financial authorization so you can help keep their bills paid and talk to bill collectors and access bank accounts. Keep in mind that these decisions need to be reviewed at least every 3-5 years. Catastrophic events happen in our lives and it’s important to try and help everyone be prepared for them.
Authorization in the absence of a Power of Attorney (POA)
You will need your parents to give you authorization to talk to all their physicians when necessary. If you don't have a Power Of Attorney the physician practice has a HIPPA document for allowing information about the patient to be given to specific people. The parents have to update this form yearly, make sure you are listed. Hospitals are a different matter, this would be where a Power of Attorney helps with getting people to keep you informed and part of the decision making process.
1. Life insurance policies need to be in one location, a safe (you need the safe code) or bank safety deposit box (you need to be on the authorization list for the box as well as have a key) works to access it on the death of a parent.
2. End of life instructions, funeral planning and burial services. Having these documents in advance takes the pressure off the living spouse and grown children. Easier to follow instructions than to make it up as you go.
3. Healthcare directive or living will which gives the hospital the authorization to take care of and/or lifesaving treatment if the patient is considered terminal or irreversible.
4. OOHDNR, out of hospital do not resuscitate order for emergency responders to direct when they should or should not give life saving procedures such as CPR, breathing tubes or artificial ventilation when a 911 is called to the home.
5. There should be an authorization to release medical records, generic form, for all medical records from all the types of facilities used and physicians seen.
6. You will need the death certificate to help with getting life insurance to pay the surviving spouse benefits, banks to allow transferring of funds to the surviving spouse if the accounts are not joint accounts.
7. Long term care plan and insurance policy for continued care or extended care due to stroke, hip fracture, major surgery. This could be using a rehabilitation facility or a nursing home, and would help with determining length of stay, amount per day paid, and authorization for payment to the facility. Otherwise the path becomes Medicare for 90 days and then getting approval for Medicaid for payment of monthly balance after personal funds are depleted. I will go more in depth on this in the next article.
Finally personal documents should be kept in a safety deposit box, safe, or notarized copies with the attorney.
Birth certificates
Marriage and divorce records
Military records (necessary for admission into a VA facility for care)
Drivers’ license and or passport
Social security card
I am sure you have the deer in the headlights look, wondering how do I accomplish this? Well, one item at a time. My personal recommendation is to find an eldercare attorney, someone who specializes in the process for our parents. Their expertise is well worth the cost and peace of mind getting the best plan of action for quality care and after life solutions. They often can smooth the way with parents as well. Your parents are going to feel like their independence is being taken away from them, This is not the case, we are helping to keep them as independent as long as we can, but safeguarding their future in the case of health issues or death.
We spent months trying to find the documents needed, because dad with progressing dementia started hiding things. Or putting things through the shredder and then trashcan. After months all documents were found, thankfully. Our attorney was a tremendous help with the legal aspects. The courts can help giving you access to joint funds at the banks
The anger and frustration that a family goes through navigating this process is unmeasurable. My mom would be in tears, dodging calls from the attorney because she felt so overwhelmed every time they wanted more documents that we couldn’t find. All she wanted was her husband home and why wouldn’t they let him? Covid didn’t help because facilities closed visitation, which for the “elderly” with terminal spouses is mentally crushing. If we don’t get this done while they are emotionally and physically sound, we are doing them a disservice. Please don’t think you can wait a week to talk, and it turns into 5 years, or you will be in the same predicament we were in. Step in, step up, do it for them. When they say they have it covered, say that’s great, tell me the plan.
Take that first step and start getting the list of items checked off. While they are healthy and aware, do this for them. You will be glad that you took the hard road by making the road smoother and less stressful later.
