Aging Options

To Age at Home, You Need More Than a Power of Attorney

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If your goal is to age at home, a health problem during your retirement years can create a housing crisis if you can’t come home because you are incapacitated by an illness or injury. You could be forced into institutional care against your will. Do you think I’m exaggerating? I’m not. As an elder law attorney, I’ve watched this play out hundreds of times.

What is the lawyer’s solution to this crisis? It’s a legal document called the Power of Attorney. This document grants your named agents the legal authority to do whatever they deem appropriate to ensure your safety and well-being. The Power of Attorney comes in a variety of forms—the Financial Power of Attorney and the Healthcare Power of Attorney are two of the most common.

The Power of Attorney plays a significant role in housing decisions. Fast forward to the day your health fails. You have a stroke and you’re in the hospital.

What does the Power of Attorney document tell your agent to do when you end up in the hospital?

Nothing! Cue the crickets.

Your Power of Attorney gives your agent authority and responsibility, but absolutely no direction. For that, your agent will be forced to read between the lines, and when they do, they will find an assumption:

I love you. I trust that when you come to my aid, you will figure it out.

Figure what out?

The “it” is never stated in the document.

Let that sink in.

Your Power of Attorney Won’t Help You Age at Home

How does this play out in real-life housing decisions after a health crisis ?

Let’s come back to your stroke scenario. You’ve been in the hospital for a while and you’re making a good recovery. The social worker comes to the agent you named in your Power of Attorney—let’s say it’s your daughter—and says, “It’s time to discharge your parent. Which rehab center do you choose?”

What does the Power of Attorney paperwork say about how your daughter is to handle this situation?

Nothing.

To make matters worse, if you’re like most Americans, you’ve never actually talked to your daughter about what she should do in this situation, at least not in a way that will bring clarity to what she must do at the time. Your plan for housing is built on the shaky foundation of assumption and hope. You assume that your daughter knows that you don’t want to go to a nursing home, and you hope that your daughter will figure out a way to make that happen. Perhaps your daughter had assured you in the past that she would not allow you to end up in a nursing home.  But, there was no plan on how she would achieve that outcome without becoming your unpaid care giver. So, there’s probably a prayer somewhere in there, too.

What decision will your daughter make?

Which rehab center?

The social worker is tapping her foot, waiting for an answer.

Remember, your daughter doesn’t have any instructions on how to handle this situation. She has no way of knowing that the choices she is being given (choosing a rehab center among several from a list) are reflective of the medical system’s preference for institutional care as the best option for older people when there is concern about safety in the home.

“Which rehab center?” The social worker asks the question again.

What will your daughter say?

The response is likely to be, “What do you suggest?”

If you’re lucky, your daughter will say, “I will do some research and get back to you.”

Most people in your shoes aren’t so lucky. In the end, more likely than not, your daughter will look to your health care provider for direction. Your daughter probably won’t push back against the hospital’s desire to put you in rehab.

Why does this happen? Here are a few reasons:

  1. Your daughter probably has no idea that pushing back is even an option because most of us are accustomed to following the direction of healthcare providers.
  2. Your daughter may think that her decision is only between “this rehab center or that rehab center,” not “rehab center or home.”
  3. Your daughter may not have the time or the willingness to do the research needed to make a decision.

There will be no discussion about the possibility of your receiving care at home because you have done no planning around this issue. You never imagined that you would need to be rescued from the hospital, and you were assuming that your Power of Attorney document would be sufficient. You might even accept that rehab in a rehab facility is a good idea given the care needs you may face at the time, not recognizing that the same care could be arranged at home. 

You won’t be alone in this quandary. This is what happens to most Americans.

Simply hoping to live out your life in your own home is NOT a reliable plan. Praying that your agents make the right decision without giving them the tools to do so is little more than wishful thinking. Hoping and praying that you’ll be able to come back home without a plan to make it happen almost certainly guarantees that you will be forced into institutional care against your wishes.

Max Wanted to Age at Home, But His Family Had Other Ideas

A few years ago, I worked with a couple that I’ll call the Smiths. Dan and Susan were both high-level executives in their respective fields and well situated financially. There were no children. I was helping them create their LifePlan for retirement.

Susan called me one day. “We have to put our planning on hold,” she said. “I need your help with my dad.”

She told me the story. Max, her elderly father, had fallen ill and was admitted to the hospital. From there, he was discharged to a rehab center. That’s where I met the family. The doctors were recommending that Max go to a nursing home.

This was the classic crisis planning case that I see every day as an elder law attorney. Through her work with me, Susan knew that I could help the family avoid this outcome for Max, and so she asked for my help. 

I met Susan and a few of Max’s family at the rehab center. Her mom (let’s call her Doris) was there, along with two of Susan’s brothers. As I sat with the family, I noticed that Doris was looking at a stack of brochures from companies that make money by placing older adults in long-term care facilities.

“What are your goals for Max?” I asked Doris.

“We want to be able to bring him back home,” she said. “I don’t know how that’s going to work out. Everyone’s telling us Max won’t be safe at home.”

After a thorough analysis of her financial situation, I could see that this was a very wealthy family. They would have no trouble paying for the care Max needed, for as long as he needed it. “The doctors tell us that Max could live two months or two years,” Doris told me.

After visiting the family, I went to see Max. He was intubated and couldn’t speak. Afterward, I met with Doris and her family. “We can arrange for care in the home if that’s what you really want,” I told her. “Before you make a decision, let me bring Jan, my care coordinator, to your home so she can complete an assessment of what it will take to bring Max back home. Then, you and the family can decide what you want to do. Remember, I want all family members to be there for the meeting.”

On the day of the appointment, Jan and I pulled up to a palatial residence with a sweeping 180-degree view of the Pacific Ocean.

Jan walked through the house to determine how suitable it would be for Max. Like most homes, it was not age-friendly. There was no bedroom on the main floor. “We could make this dining room into a very livable, temporary bedroom on the ground floor,” she said. Before the meeting, Jan told me privately that she had reviewed Max’s medical records. It was doubtful that he would live more than a month or two. This temporary solution would likely be sufficient.

After the assessment, the family gathered to hear Jan’s recommendations. All their children—five boys and two girls—were in the room, along with about several grandchildren.

Jan explained the assessment process. Next, I shared my recommendations. “It’s possible for Max to come back here if you convert the dining room into a temporary bedroom and hire caregivers to look after him,” I said. “Hopefully, he’ll get better, but if not, at least he’ll be able to live at home. If I were living in this house, I would have probably made a bargain with God that I don’t want to die any place other than this house.”

A few people chuckled. It was a nervous laughter.

After a long pause, Doris spoke. “So, what kind of costs are we talking about?”

“Your husband is a bariatric patient,” said Jan. “We will need to bring in two registered nurses and the cost will be somewhere between $15,000 and $20,000 a month.”

Doris gasped.

This family was rich. How was money even an issue?

Doris looked down, shaking her head.

More silence. These aren’t easy conversations to have.

The oldest son looked at me. “We need to think about this,” he said.

“If you want to keep your dad at home, you know what needs to happen,” I said. “If you want to place him in a nursing home, then somebody from the family needs to be there with him holding his hand. You need to be with him. He should not just be with strangers.”

“Well, Rajiv is right,” the oldest son said. “We will be there with Dad. He won’t be alone…”

After what felt like an eternity, the son who had driven from Oregon spoke. “I totally disagree,” he said. “We know that dad wanted to come back home. Rajiv said he could make that happen. Why would we not want to do that?”

There was palpable tension in the air. It’s a cliché, but you really could cut the air with a knife. Everyone was either looking down at the floor or nervously shifting around in their seat.

I let everyone marinate in the silence. I’ve learned to let these questions hang. Who is right? Who is wrong? There’s no answer. The family has to work it out. Whatever they decide to do, I will support them.

Every single expensively clad person in that beautiful room on the coast was advocating from their own perspective. Now, take a moment to imagine Max Smith’s perspective. You’re lying there in the rehab center. You’ve told your family that you want to come home if you fall ill. That day is now here. What will your family do? They all want to do right by you. However, what’s right by you may not be what they decide.

Finally, I stood up. “Why don’t you think about it?” I suggested as I gathered my files. “Let me know your decision in the morning. Whatever you decide, we can make it happen. If you decide to put him in a facility, my recommendation would be to keep him in the rehab center as long as Medicare will pay for it. Any move you make will be hard on him.”

The next morning came—and went. No one from the family called.

Two days later, the rehab center called to let me know that Max had died.

I was stunned.

This was a rich family, a family that would likely spare no expense to do complicated estate planning to protect their fortune from taxes, yet they were hesitating to spend a fraction of that to give Max the dignity of dying in the way he preferred.

While the family was hemming and hawing, Max died in a nursing home.

Money is no guarantee  that your life won’t end in an institution.

In the end, it’s not about money at all, even though everyone thinks it is. It’s about having the right plan. Being able to continue to live at home even when your health fails takes a premeditated plan. The solution is to create a retirement plan that coordinates your plans for health, housing, financial, legal, and family issues throughout your retirement years. I call this kind of retirement plan a LifePlan.

Learn how to create your own LifePlan at AgingOptions.

From Your Retirement: Dream or Disaster? by Rajiv Nagaich, published by Hasmark Publishing. Copyright© by Rajiv Nagaich 2023.


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