Does your family really understand what’s important to you as you grow older – particularly when it comes to where and how you want to live out your days? Before you answer “Yes, they know where all my important estate planning documents are,” you might want to think again. You’re answering the wrong question.
Since many of us have named family members (especially our adult kids) as agent or executor, it makes sense that we would go out of our way to make sure they understand, not just the “nuts and bolts” of our plan, but also our deeper personal desires. They need to know what really matters to us as we age, not just after we die, but while we’re still very much alive.
Family Often Ill-Equipped to Make Critical Care Decisions
Often, however, our family members have to make critical care decisions on our behalf with zero guidance, because we’ve never told them what we want or how to make it happen. Case in point: aging in place.
Almost all seniors say they want to live out their lives in their own homes. But unless we take steps to clarify and document our desires – and let our loved ones know what financial provisions we’ve made to pay for the care we want – we’re likely to join the 70 percent of seniors who fail to live out their years in the way they want to.
This week on the Blog, we’re focusing on some of the “family aspects” of estate planning, such as how to talk about our estate plan with our family and how to make sure we’ve chosen the right executor. These elements are important, of course.
But all too frequently, traditional estate planners only deal with the mechanics of estate planning: wills, trusts, powers of attorney, advanced care directives, and so on. They seldom answer what is arguably the most important question on our minds: “Will I be able to live out my days as I choose, without being forced into a care institution against my wishes?”
Common Health Care Scenario Puts Families in a Bind
On his weekly radio program, Rajiv Nagaich has shared many times how a very common health care scenario can force families into a decision for which they are ill-prepared.
“It happens all the time,” says Rajiv. “Let’s say you’re 87, 88 years old. You’re living alone in your own home but you’re getting frail. You’ve fallen down two or three times in the past week, and the last time it happened you bumped your head and sprained your ankle. Your doctor sends you to the hospital for a few nights for treatment. Most of the cost is covered by Medicare – so far, so good.”
Rajiv continues, “But here’s the problem. Let’s say it’s time to discharge you, but the staff at the hospital has talked to your doctor. They know you’ve been falling down, that you’re getting frail. They tell your adult son, your adult daughter, ‘We’re releasing your mom tomorrow afternoon, but she’s too frail to live alone. Here’s a list of rehab centers and assisted living facilities nearby. Which one should we send her to?’”
What reply would they give?
Without a Plan and a Shared Perspective, Your Family is Left in the Dark
Sadly, Rajiv explains, at that moment your family and your physician are probably thinking of just one thing: your safety. But as Rajiv often notes, this focus on safety shows how much their perspective differs from yours.
“It’s natural,” he says, “that, when there’s a health care crisis, your kids are going to be preoccupied with keeping you safe – never mind that their so-called solution is going to make you miserable. The perspective of your kids and your doctor will be, ‘We have to keep mom or dad safe,’ and that means you’re likely heading for a care facility, which is the one place you always said you never wanted to end up.”
Rajiv adds, “So, the good news is you’ll be 100 percent safe. The bad news: you’ll be 500 percent miserable. There has to be a better way to make sure that, at the end of the day, your perspective is the one that wins out. If you value your independence and the freedom to age at home, it’s up to you to make a plan that makes that outcome the most likely.”
Creating a “Statement of Care Preferences” That Works
As you begin to take steps to prepare a care plan – we’re calling it a Statement of Care Preferences – here are a few ideas to consider. In our experience, the basic planning outline includes all or most of these seven elements:
*Getting the right professional advice;
*Making sure your home is aging-friendly;
*Planning ahead to cover the costs of your care;
*Connecting with a geriatric care manager;
*Establishing a relationship with an in-home care provider;
*Documenting your plan;
*Sharing it with your loved ones.
Make Certain You Have the Right Professional Advisors
The best way to make certain you’ve prepared the type of plan that ensures you’ll receive the type of care you want is to begin with the right advisors. You want to work with an estate planning attorney and a financial advisor who both understand the critical nature of this type of planning, and who will support you in bringing your plan to fruition.
Sadly, we find this type of proactive approach to creating a care plan to be the exception, not the rule. Plenty of advisors will draft legal documents or help with financial decisions. But few will ask the right questions to help you and your family create and fund a plan that allows you to achieve your goal of aging in place.
(We’ve recently dealt with this important topic of selecting the right advisors here on the Blog. This article provides tips on finding the right estate planning attorney, while this one addresses some ways to identify the right financial advisor.)
Make Certain You’re Aging in the Right House
Depending in the data you read, aging in place is the choice of up to 90 percent of U.S. seniors. But you have to ask the question, “Is my home a safe and livable place for me as I grow older?”
National statistics show that only about 10 percent of American homes have all the design and safety features that senior care experts recommend for aging in place. You can read more about whether your house is the right place for you to age comfortably and safely in this archived article from our Blog.
In the same vein, this Blog article outlines some repairs and upgrades that could make your home more livable in the years ahead. Some are costly but many are relatively easy and inexpensive. The important thing is to ensure your home is livable before you decide it’s where you want to grow old. If upgrades are cost-prohibitive, you might need to consider relocating.
Make a Plan to Cover the Cost of Your Care
Your loved ones may understand and even support your desire to age in your own home. But unless you’ve made provisions to pay for the care you’ll need – entirely or in combination with other income and resources – your good intentions may be impossible to realize.
If you have a large estate, paying for care is less likely to be an issue. If you’re in a low-to-moderate income situation, you may qualify for means-tested coverage for long-term care through Medicaid or the Veterans Administration.
For many middle-income couples and individuals, the cost of care can be covered, at least partially, through long-term care insurance, a reverse mortgage, or other dedicated savings. There may be other tools your financial advisor can suggest which are appropriate for your situation and income level.
(Last week here on the Blog, we featured this article on some ways to pay for long-term care.)
No matter the size of your estate, the time to meet with a well-qualified estate planning attorney and a financial advisor to review care costs is well before the need for care arises. But even if you’ve put it off, it’s never too late to start the conversation.
Contact a Geriatric Care Manager
Few families will have the expertise to evaluate the best options to care for an aging loved one. That’s why a growing number of Americans are seeking out a geriatric care manager to provide care guidance – and also to act as the family’s advocate in dealing with the health care system.
One website explains that the job of a geriatric care manager is to “help organize an elderly loved one’s total care needs,” and also to connect them with useful resources. “After conducting a needs assessment,” the site adds, “the geriatric care manager will create a personalized plan that includes all medical, legal, and financial components necessary for the patient’s care.”
Unfortunately, as our aging U.S. population triggers a growing need for care, there don’t seem to be enough geriatric care managers to satisfy the demand. Here in Washington State, home to AgingOptions and Life Point Law, the AgingCare website lists just 62 of these trained individuals covering the entire state. As might be expected, all but a few are in the much more populous western side of the state, leaving more rural areas unserved. We suspect this is true in other states as well.
We explained some of the benefits of working with a geriatric care manager in this Blog article.
Have a Conversation with a Home Care Agency
If you’re determined to age in your own home, there’s a high likelihood that – at some point in time – you’ll need in-home care. Even if your family members are your primary caregivers, having professional help in your home can give your loved ones a much-needed respite from the physical and emotional stress of caring for you.
(Planning for in-home care was the subject of this recent article on the Blog.)
As frequent radio guest Joe Hillyer of Homewatch CareGivers often suggests, scheduling a consult call with a caregiving agency before the need for care arises is a good practice. Most firms will meet with you and family members, provide an overview of their services, and explain their fee structure. Many will visit your home to assess care options.
By establishing this connection before you require care, you’ll have time to do your homework and compare care providers. Then it will be far easier and less stressful to start getting the in-home care you need, when you need it.
Document Your Wishes Clearly and Completely
You may have taken all the steps outlined above. You might think you’re well-prepared to age in place, in your own home, with needed care coming to you.
However, unless those responsible to carry out your wishes are aware of the plans you’ve carefully made, they are all too likely to follow the advice of the health care professionals who are more concerned with your “safety” than your happiness. In other words, you will probably become part of the 70 percent whose dreams to age in place are never realized.
Your estate planning attorney can help you prepare appropriate legal documents that will then become part of your estate plan. Another option is to draft a letter to your agent or executor (and any successor agent you might have named) clearly stating what your wishes are and what preparations you have made to pay for the care you’ll need.
Elements to Include in Your Statement of Care Preferences
Your letter to your family or other agent, which we’ve unofficially called a Statement of Care Preferences, should be dated and signed by you and also by your spouse if you have one. You may choose to have it notarized or witnessed to make your serious intent clearer.
Your letter should state unambiguously that it is your desire to live out your days in your own home, with in-home care coming to you. Make it clear that you are drafting this document as a means of limiting the likelihood that you will be placed in institutional care.
Next, you should also list the financial and legal advisors with whom you have consulted. By including their name and contact information, you’ll be making things much easier for your agent. We suggest you add the name and contact number of a geriatric care manager if you have one. These professionals can become your key advocates, helping ensure that your desires are carried out.
You should also specify an in-home care provider if you have identified one, with contact name and information, plus an account number if one has been set up for you.
Finally, identify the sources of funds set aside for your care, and the amount if you have it. Some possibilities:
*”We have a reverse mortgage with (company). Our contact there is (name). Our current borrowing limit is (specify).”
*”We have long-term care insurance with (company). The benefit amount is (summarize the terms – e.g., $3,000 per month for 36 months).”
*We have set aside savings accounts at (institution) for our care, in the amount of (specify).” Make sure your agent has access to these funds as your financial power of attorney.
These are just examples. Remember, the point of this Statement of Care Preferences is to give your family members a road map to get you the care you need, when and where you need it. This letter is designed to go hand-in-hand with your other estate planning documents, especially your powers of attorney for finances and health care.
Share Your Wishes and Plans With Your Family
There are several appropriate ways to inform your family of the preparations you have made for your long-term care. The important thing is to have the conversation.
Choose a time when you won’t be interrupted. If you have grandchildren, especially young
ones, this is a good time to leave them with a baby-sitter. Also, if at all possible, have the conversation in person, not via Zoom or telephone. Allow plenty of time to go over the plans you’ve made and answer questions. Meet at home, not in a noisy coffee shop.
Anticipate some initial uneasiness. Most families prefer to avoid any talk of mom and dad growing old. But while this is a serious topic, it needn’t be a somber one. After all, the goal is information and preparation. Keep the discussion from getting too heavy – or as one expert put it, “Lighten up but don’t let up.” We expect that your loved ones will be extremely relieved to see the preparati0ns you’ve made.
One final word: if a family conference seems appropriate, please contact us. We often find that family members respond well when sensitive conversations take place in neutral surroundings, professionally facilitated by a member of our legal staff.
Meanwhile, remember: “Age on!” And do it in your own way.
(original article)