Are You Planning to Stay Out of the Nursing Home?

It May Not Happen By Accident!

Nursing Home admission is one thing we don’t even like to think about, let alone do planning around. But today, I’m not talking about planning to go to a Nursing Home. Rather, I’m talking about planning to stay OUT of a Nursing Home. Now you may be one of the lucky ones who will remain in great health up until the day you die and just never have to go to a long term care facility. But rather than wagering with life, it’s best to have a plan in place for your family to follow so actions can be taken to help you live the remainder of your life as you would wish.

Stacking the Odds In Your Favor

There are several actions you can take to stack the odds in your favor. We are covering a few of them here.

Do your own planning while you are able.Years ago when we started practicing law, the statistics were something like: 70% of people never have a plan and 30% of the people do. After 30+ years of practicing law, I think it’s probably a little worse than that. Congratulations if you are part of the 30%! But if you have estate planning documents, do they do anything to help you realize your goal of staying out of the Nursing Home? If not, stay tuned.

If you have no planning documents in place, you are in very good company! But the good news is that if you are reading this, most likely you still have the cognitive ability to map out your own Staying Out of Nursing Home Plan and to take the action steps to make that happen.

Working with Family

You may be fortunate enough to have an ample supply of healthy and cooperative family members who will do everything possible to help you implement your plan. If this is the case, I would suggest that you conduct a Mom (or Dad) Centered Family Meeting, where you discuss the following items with your family.

Preferences

Talk with your family to let them know what type of care you would want in the event that you are incapacitated; where you would want to be; who you would want providing the care; when you would like to care to begin; where you would like to receive care, and; how you would want that care to be paid.

Finances

This is usually a big issue that is never discussed – at least it’s never discussed until the time comes when it really needs to be discussed and then it’s often too late. It’s a good idea to have at least an annual review with your financial advisor to make sure that your money is invested properly for your age and station in life. It’s also good to discuss whether that money can be easily accessed and used for your care with that incurring substantial taxes or penalties.

This is a big topic worthy of its own separate edition but a few things to be concerned about are: Who would want making decisions for you in the event of your incapacity? Have you legally authorized this person(s) to take actions on your behalf? How much authority do they have? How would you like your assets passed at your death? Your estate planning documents may also need to incorporate any care plan implementation decisions as discussed in Part B below. If you don’t have legal documents in place or haven’t had them reviewed for quite some time it would be a great idea to set an appointment with your elder law or estate planning attorney today. If you wait until the point in time that you lose capacity to understand or reason, it will be too late to plan.

Pre-Meeting Communication

It’s important to have conversations with immediate family members prior to the Mom Centered Family Meeting so that they can know what to expect and be prepared for the discussion. Additionally if you need assistance in gathering information prior to meeting it may be helpful to delegate some information gathering tasks to family members. This not only spreads the workload but can make them feel more part of the planning process.

MOM Centered Family Meeting

Again, this is a big topic, but this is where it all comes together. The family gathers the information mentioned above, plus other relevant information that needs to be discussed – then meets (hopefully as a united family) with the sole purpose of crafting a great going forward plan – great for Mom and great for the family.

Implementation

This is where the rubber meets the road. Normally all of this happens after a parent becomes incapacitated. The kids get together to craft a hastily prepared plan and go forth to put the plan into action. Even if you are one of the adult children reading this and you are the one having to take quick actions on behalf of an incapacitated parent, you can get better results by following this process then just “winging it”.

However if you are the parent reading this just know that putting a plan in place ahead of the need can give tremendous direction to your family and can help make your wish much more likely to become a reality when the time comes.

Pivot Plan

Things rarely work out exactly as planned. Try as you might to come up with the perfect plan for Mom and the family – you will likely encounter some twists and turns in the road that you did not anticipate. This is why it’s great to proactively anticipate things that could happen and have a plan in place to deal with those contingencies should they occur later. A well thought-out pivot plan can help you avoid hastily conceived emotional decisions that may produce very different (off-the-original-plan) results.

Plan B: Making it Happen

What if your children live remotely or you don’t have any close family members available to help turn this plan into reality? In situations like this, we have to look at an alternative course of action which we will refer to herein as “Plan B”.

This plan may start with the same type of planning and legal documents when it comes down to implementation. But in addition, other implementation provisions have to be incorporated. For example:

You may wish to incorporate the following professionals in the planning process

  1. A corporate trustee to hold and manage your money. The trustee would step in at the point of your incapacity and use your money for your care and pursuant to your directives.
  2. Life Care Planner or Care Manager will oversee your care and will be tasked with ensuring that you are receiving the type of care you want. If you want to remain at home, the Care Manager will coordinate care providers as necessary to provide that care.
  3. Hands-On caregivers who will provide the daily care. These caregivers provide care as needed and are usually managed by the Care Manager mentioned previously.
  4. Your adult children can still be involved in this “Plan B” planning scenario. The care manager and care providers would be doing the day to day “heavy lifting” but your adult children know you best. Even though they may live at a distance, they could monitor this process to make sure you were getting the care that you want and need.

This may seem like an extreme approach but in many cases it works rather well to ensure that you actually get the type of care that you want. In this example your assets would be used primarily for your care, then at your death any remaining assets would be distributed in the way that you had designated in your estate planning documents.

We wish you the best in your efforts to implement a plan that will help you enjoy the quality and type of care that you want in your final years of life. Best of luck in your planning to stay out of the nursing home, or to keep Mom out!

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