As a former lifeguard, I know better than most how quickly the ocean’s mood can change. I understand how dangerous it can be if you enter the water unprepared. I found I could spot the weak swimmers pretty easily. Their poor form and stamina told me that if a set of big waves came in they were going to be in trouble.
With this image in mind, I sat down recently with Carolyn Rosenblatt. A registered nurse, elder law attorney and mediator in family matters, Carolyn has a wealth of knowledge and decades of experience in helping families enter the metaphorical waters of an elder family member’s later life.
On the beach, green, yellow and red flags indicate the threat level of conditions in the water. As I spoke with Carolyn, I could almost imagine a flagpole in the middle of the family living room indicating the financial threat level to aging loved ones.
Too often, no one wants to look up to see what color flag is there.
Yellow Flag: Proceed with Caution
We take down the green flag and put up the yellow when we realize our parents are entering the last few decades of life. At this point, questions and concerns start building quickly: Who is authorized to help Dad get hearing aids if his hearing goes? Who will be responsible for Mom’s medical care if she develops dementia? Do we know what to do if they lose their decision-making ability?
Carolyn understands that although these are common concerns, family members often don’t know how or when to address them.
Joe Delaney: What is the most challenging part of confronting aging issues in the family?
Carolyn Rosenblatt: One of the most common issues I see is initiating conversation with the aging parent about what will happen in the future. We don’t like to talk about what might happen to us. Many people don’t like to sign wills and other documents because it means they might die. Yes, they “might!” Also, we’re death- and disability-phobic. People fail to anticipate that they might not be 100 percent capable until they breathe their last breath. It is difficult to bring up these issues with loved ones.
JD: When should we have “the talk” with our aging parents?
CR: There’s a lot of conversation about the so-called “talk.” I think it’s a mischaracterization of what people need to do. It’s not just a talk; it’s a series of conversations. I recommend setting a date for that first conversation. It could be Dad’s birthday or date of retirement, anything.
JD: Who should initiate these conversations?
CR: It’s usually up to the adult children or younger spouse. Whoever is most inclined and most capable should say, “Mom, Dad, it’s time we had a talk about plans for the future and what we’re going to do if you have an accident.” The word accident is less threatening than dementia or Alzheimer’s. It’s easier to frame the scenario as, “If you got bonked in the head, we need to know how to find things: accounts, passwords, etc. By the way, do you have a durable power of attorney?”
Red Flag: Hazardous Conditions
Just as I saw many near-disastrous situations in choppy waters too hazardous for weak swimmers, Carolyn has seen many situations in which families did not heed warning signs that an elderly family member was beginning to lose their independence. Incidents that happen when the red flag is up can have serious consequences.
JD: What does it look like when an elderly loved one loses their independence and the family is not prepared?
CR: I remember once meeting with a woman who was in tears. She was in a wheelchair temporarily because of an injury and had just gotten out of a nursing home. The purpose of her coming to me was to talk about the transition of [financial] power from her husband to her, but he had been developing Alzheimer’s disease for years and had finally gotten physically violent. He was taken away and placed into a facility within 24 hours of hitting her. She said, “Carolyn, you see it right there in front of you. You know it’s happening, but you just don’t want to face it.”
JD: What are some signs that an aging parent might be in the first stages of developing dementia?
CR: The most common presenting problem is short-term memory loss. The second is confusion. We all forget our car keys, but not what they’re for. If Mom and Dad have always been meticulous about paying bills and they begin to neglect them, there are serious consequences. If you forget to pay your insurance premium, you’re uninsured. Then it’s just bad luck when you have to go to the hospital immediately after that. They could be cut off from that insurance and be stuck with a huge bill. It’s a nightmare.
JD: If my aging parent has to go into a nursing home, can’t I rely on Medicare to cover the cost?
CR: One of the most common mistakes people make is thinking that if you’re 65 and you’ve paid into it all your life, Medicare will take care of you. I’ve seen jaws drop when people find out Medicare does not pay for long-term care. It does not pay for a nursing home for longer than 100 days, and only up to 80 percent of the cost. A supplemental plan will pay for the other 20 percent, but it only covers what Medicare does. People don’t realize that there is a lot Medicare doesn’t cover: dental care, vision, hearing aids, things people need as they age.
I took away from my conversation with Carolyn two critical lessons:
1. Begin talking with your aging parents about what could happenif they have an “accident” (think not just physical injuries, but conditions causing loss of independence that no one really wants to discuss) before you see warning signs. Set a date and start making a plan.
2. If you see warning signs that look like they might be red flags, get helpfrom a trusted advisor who can guide you through how to address the issues which arise. The consequences could be dire if you just let it slide and hope for the best.
Finally, I recommend ensuring that your aging parents have five key estate planning documents: an advanced health care directive, powers of attorney, a HIPAA release, a will and a living trust.
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