Bridge of Life planning is all about helping a declining parent get what they want during a period of decline of physical or cognitive health. If they (and you) are fortunate, Mom and Dad have already planned and have set forth what they want. In a perfect world, their plan includes where they want to be should they suffer a health crisis. Hopefully, they have also figured out how to fund their health care during a time of crisis. But, unless they are in the small group of people who do such planning (less than 30% of the U.S. population according to various estimates), you are probably on your own.
Hopefully, they still have the cognitive ability to plan. If so, after you read this, you should ask them to set an appointment with their attorney or a local elder law attorney and financial advisor as soon as possible. Capacity is a slippery slope. It’s critical that they put their plan in place while they can still do so. As you will discover from this post, a complete Bridge of Life Plan includes more than just “writing a will”. If Mom or Dad still has capacity and is willing to plan, then your job may be defined as cheerleader and/or chauffeur (to drive them to various appointments).
Download our Alternatives in Care Tip Sheet today to learn the 7 top options.
Does Mom or Dad Have a Power of Attorney
However, if they haven’t planned or are no longer able to plan, then planning options are more limited. Though limited, the options are still very much worth pursuing. Good results can often be obtained by doing some planning, even at the last minute. As we will discuss in the legal section of the Bridge of Life Overview, it is very important that Mom or Dad has appointed someone as their Attorney in Fact. The Attorney in Fact will need to make healthcare, property and financial decisions on their behalf should they be unable to act for themselves. If that is you, you may be able to take some actions to help on their behalf.
If you are acting as attorney in fact, under a Power of Attorney, it is critical to remember that you are their fiduciary – that is all actions must be done in their best interest – not yours. It is also important to be very transparent. If your parent has lost cognitive ability to make decision for themselves, then read our blog post on conducting an effective Family Meeting and make sure all siblings are on board. Many family squabbles could be prevented with transparency and good communication between family members.
Even if your parent has lost some physical functioning, but still understands business matters and make decisions, it is important that they make their own decisions, see advisers of their own choosing and make their own financial decisions. Your parent should have minimal help from you or anyone else. If you or anyone else “helps’ too much, then it will appear that you unduly influenced their decision.
What Planning Decisions Does Mom or Dad Need to Make
If you are the adult child who has assumed the responsibility of helping Mom or Dad as they decline, then you are very familiar with doing many of the tasks necessary for their daily functioning. You may often wish that you had extra helpers or resources. Conversely, you usually just do the best you can with what you’ve got. But sometimes, you encounter an issue that is huge. You can’t help but thinking, “If only we could dial the clock back a few years, we would have done things differently”.
Uncovering obstacles before they happen is what Bridge of Life Planning is all about. It starts when you (probably adult child or “well” spouse) sit down to have a conversation with your declining Loved One. Hopefully you have this discussion while your Loved One is well enough to offer their input. If not, usually these decisions are made based on consensus of the siblings at a Family Meeting, referenced above.
There are three big pillars Bridge of Life Planning is founded upon. We will tackle one of the pillars in each of the next few Blog Posts. Today, we will discuss the Pillar of Preference.
Pillar of Preferences
What does your loved one want? Sounds pretty simple; but it’s not. I recently visited with a man and his Daughter and quickly discovered that neither one of them had thought about this question at all. Until now, Dad had been blessed with good health. Hence, he had not spent any time thinking about what he would want if his health declined. For such an important issue, you would think that some significant thought and discussion would go into it. However, this usually doesn’t happen until after something bad happens. If you are lucky, maybe you get “a warning shot across the bow” which alerts you to the fact that “now it’s time to have that family discussion”. Here are a few of the topics to be discussed in the Preferences category:
Who do you want in your home?
If your health declines and you need help in your home, who do you want coming in to help? I understand that you may not want anyone coming in to your home. But, if you get to the point where you really need help, the two initial choices are usually (1) Family or (2) Professional Caregivers. Let’s briefly discuss Family first.
Family Caregivers could be your kids or other family members. They are able and willing to come into your home to assist you with some of your activities of daily living. The problem is, they are often busy with their own lives. Time limitations may not allow them to devote enough time to help with the tasks that you need assistance with. If you have several children who are willing to help, they can create a schedule to coordinate care. A more involved version of would be if you move in with one of your kids or if one of your kids moves in with you (both topics of future blog posts).
Professional Non-Medical Home Care
This is a non-medical home care company that (for a fee) provides non-medical care in the home. Typically these companies may offer other services as well. Meal preparation, medicine reminders, light housekeeping, local transportation and other basic tasks can be included. Services will vary so you should definitely check as to what is offered. It is also good to check to see whether they have a deep roster. If Caregiver “A” is sick one day, do they have Caregiver “B” that they can dispatch on short notice? Sometimes folks don’t want “strangers” coming in their home on a daily basis. For this and other reasons, facility care may be preferred.
Assisted Living Facility
These facilities provide assistance with one or more activities of daily living, such as feeding, dressing, bathing, toileting or transferring. Assisted Living Facilities are generally very nice, but offer limited medical assistance. You pretty well need to be able to fend for yourself, with just a little assistance. They do normally offer meal preparation, housekeeping and (some of them) offer a whole array of social activities. Some even offer Memory Care Units for residents who are suffering with Alzheimer’s Disease.
Skilled Nursing Facility Care
If your health declines to the point where you need skilled medical care on a daily basis, a traditional nursing home level of care may be required. Few people look forward to this, but when you need this level of care, it’s good that they are there. Nursing Homes have generally improved a lot over the years, but if this is an option, you should tour several so that you can choose the one best for your family.
These are just a few of the care options available and a few of the decisions that need to be made when the decline starts. When a Senior declines to the point that they are no longer able to care for themselves, some quick research has to be done AND the family has some big decisions to quickly make. To assist your family with this process, download our Alternatives in Care Tip Sheet. This resource lists the Top 7 Care Options and highlights a few of the main points to consider for each. This is a helpful resource when quick decisions need to be made.
Another big issue with all of these options is cost? How will we pay for them? This, among other financial issues, will be discussed next time in Bridge of Life Planning / Part 2. Stay tuned…
I have a nursing home policy, when and how do I thing about going that route? I am going to be 83 and thinking about what and how?
Well, the decision to go to a Nursing Home has a lot of factors to consider. Two big ones: Is it necessary? and Is it what I want? To be honest most people do not choose to go to a Nursing Home but are rather placed there because their caregiver can no longer provide proper care. Most people who “choose” to go somewhere other than home would start with Independent Living or Assisted Living first. If those are not options for you moving forward you would then go to a Nursing Home.
Please keep in mind that with most of these policies there is an elimination period meaning you will need to wait from a few days to three months before the policy will actually pay. During that time you would submit the claim to the insurance company. At this point, the burden to prove you require such care begins. The insurance company will require a lot of paper work from you, doctors and the nursing home. This is why you need to get the claim started right away. I’ve seen some of these take upwards of six months to pay out. Of course they wrote a huge backdated check, but you don’t want to wait to file a claim for sure.
Lastly, but still very important, you NEED to speak with an elder law attorney in your area regarding Nursing Home Asset Protection and Medicaid. There may be ways to preserve a large portion of your assets while getting approval for Medicaid and letting the Long Term Care Nursing Home Policy pay off any penalty period created.
If you need help in Arkansas with this, we specialize in this at our Law Practice. If not, we can get you in touch with someone in your state. Let me know!