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Caring for Aging Parents

As children advance from adolescence into adulthood, common areas of focus are on what college to attend, what job to pursue or which career path is best. Many will also focus on starting a family of their own. Careers advance for these children, and their own children grow. These children then have children who head off to college and career paths as the cycle of life continues.  But this is where the story can take an unforgiving turn, because as advances in health and science continue to elongate life expectancies, these children, in their 30s, 40s, 50s and 60s, may one day be in a position where they need to provide care for their parents.

According to the U.S. News and World Report, over the past decade, the number of adult children caring for an elderly parent has risen dramatically. While there may be some debate as to the extent, or rate at which this percentage is rising, it is certain that in order for you to be ready to take on such a large responsibility, preparation is the key.  This module will provide you with a basic framework to help you consider whether you are ready for this responsibility.

 Things To Consider

If your family is considering caring for an older parent or loved one, there are a number of issues you should consider before making a commitment. Let’s take a quick look at some of the more important potential issues:

Time
Providing care to an aging parent often requires a great deal of time. Regardless of whether your parent is able to fully function on her own, or if he/she needs constant care and attention, caring for a parent will take a lot of time. You must first consider whether your current lifestyle will allow you to spend time helping someone else.  If the answer is no, then you should next ask yourself if you can make adjustments to your current lifestyle that will free up more of your time to do so. 

Care Level
It is important to consider not only the level of care your parent will require now, but also in the future. While having the paper in the house each morning at 7:00 a.m., or putting just the right amount of peanut butter on your father’s toast may take some getting used to, you enter an entirely new realm of care if your father has a catheter that must be changed twice a month. Be sure you understand the full spectrum of what care your parent needs, and what care requirements could potentially be added in the near future before taking on the commitment.

Ultimately the level of care your aging parent requires will determine, to at least a certain extent, the cost to provide your mother or father with in-home care. This workbook is a MetLife resource designed to identify the cost for an individual to maintain their own residence throughout their life. This Genworth database outlines the cost of various types of elder care throughout the United States.

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Finances
If you or your spouse is going to have to work less, or even resign from a job, to care for an aging parent, you must consider whether or not the loss of income will have an impact on your ability to support yourself. Consider the following two questions: Are you in a position to use some of your resources to help care for someone else? Do you have the resources to cover your own medical expenses going forward, both those expected and those unexpected? You also have to look into your parent’s finances to see if he/she has any resources to help. Regardless of the amount of resources and insurance available to use for the care of your parent, if you take on the responsibility, it is likely that you’ll have to pitch in some of your own financial resources.

Logistics
If you’re adding a new resident to your home, you must evaluate how that is going to work - from the simple things of where your mother will sleep, to more complex issues like your mother having appropriate access to your home, restroom and even showering facilities.  Welcoming an aging parent into your home may require some significant remodeling expense, such as creating a wheel chair ramp.

Career
Will you be able to continue your career and care for your parent? Will one spouse sacrificing his or her job put a strain on that relationship? Will resigning your current job damage your retirement savings? If caring for an aging parent requires one, or both spouses to give up, or alter a career, be sure to investigate all potential consequences of that decision before making it final.

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Insurance and Benefits
Before beginning to provide home health care for your parent, be sure to take the time to thoroughly understand what benefits are available for both your aging parent and possibly you as well. You should also make sure that if your parent is qualified for benefits, that moving in with you will not have an impact on receipt of those benefits. Eldercare.gov has a great database to help you find resources for no-cost or low-cost benefits for elderly parent care.

Furthermore, you should determine what resources are available to your aging parent, such as Medicare and Medicaid. Additionally, you should take a look at your insurance benefits to determine what will still be available to you should you have to take time off or reduce your status to part-time.

Family Relationships
If there are multiple children who could potentially care for an aging parent, try to devise a way to determine which option is best; best for your parent, and best for your family. Consider geography, personality and finances to determine which sibling should take the lead in caring for your parent. But, it is important to keep in mind that the more each sibling pitches in to help, whether with financial resources or a time commitment, the lighter the load will be for everyone. Don’t forget to consider who gets along best with your parents as well. If you and your aging father always fight about politics, be sure to keep that in mind. Issues that are small will be enhanced as you spend more time together, especially under what can be stressful circumstances.

Your Capability
Helping to care for an aging parent can be an emotionally taxing experience. Do not be afraid to ask yourself tough questions about what you are capable of dealing with. You may want to consider using a professional geriatric care manager to guide your parent’s care, or to assist you in providing resources to your aging parent. The National Association of Professional Geriatric Care Managers is a great resource to help you locate a professional geriatric care manager in your area.

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Areas to Consider When Caring for an Aging Parent

As you determine whether to take on the heavy (and potentially stressful) burden of caring for an aging parent, there are several areas you should plan for prior to making that commitment. As with all things in life, proper and detailed planning will not only enhance the chances that a particular undertaking will work as you expect it to, but it can also help you to anticipate, and be prepared for, potential roadblocks and setbacks. As you consider how to go about caring for an aging parent, planning is a crucial element to putting yourself in a position to deliver quality care for your loved one, while maintaining your own health and stability. Let’s take a look at each of the areas that will need to be considered in your planning process.

Finances
Being able to financially care for an aging parent requires answers to many different questions. First of all, you’ll need to take a closer look at your parent’s finances and answer the following questions:

  • What resources do your parents have available for care?
  • Do your parents have the resources in place to be financially self-sufficient?
  • Are your parents operating in their life now in the black or in the red?

Second, you will need to take a closer look at your personal finances and answer the following questions:

  • Are you in a strong enough financial position to potentially reduce your income (as you spend less time at work and more time at home caring for your parent)?
  • Do you have the disposable income to make necessary home modifications if needed?

Finally, before making any decisions on how you will care for an aging parent, review your budget, your parent’s budget, and create a new budget to see if you will be able to make things work financially. Although changing lifestyle and residence, and ceding control and a certain level of independence, can be hard for an aging parent, those issues pale in comparison to the stress and strain a lack of financial resources can have on you and your new house guest, should you not properly plan how the finances will shake out.

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Medical/Care Resources
Before you commit to care for an aging parent, you want to be sure you understand the scope of what you are getting into, and what help may, or will, be available to you. Consider the following questions:

  • What level of care does your parent need? There are significant time requirements and costs associated with an aging parent that cannot feed or bathe themselves versus an aging parent capable of performing daily tasks but unable to drive.
  • Are there resources that can assist you in the care you intend to give, such as a home health care service? 
  • Are there any local programs or resources that can take your parent to appointments during the day?

Answers to these questions will help you gain a greater understanding of what will be required of you and what resources you can turn to in order to care for your aging parent. These answers will also help you identify any hidden or additional costs that may pop up unexpectedly.

Parent Wishes
Many older Americans are used to, and comfortable with, a life of relative independence. Growing old can be stressful, and that stress may manifest itself in a variety of ways. When considering if it’s time for an aging parent to begin relying on you (or anyone else for that matter) for regular assistance with daily tasks, you’ll likely need to have “the talk” with your aging parent. Whether the situation looks to be temporary (e.g., your parent has fallen and broken a hip and requires a six-month convalescence period), or a more permanent (e.g., your parent is no longer able to manage the his/her own household or provide for his/her own basic needs), it is essential that you secure buy-in from that parent for a smooth transition. If your aging parent does not believe his or her situation will prevent him or her from living life “as usual,” you will have the unenviable task of sitting down and discussing the hard realities that your parent needs to face. If your parent is able to see the need for assistance, and ultimately makes a choice to be cared for, rather than having care forced upon him or her, your transition will likely go much smoother.

Consider having a family meeting where adult members of the family can openly discuss fears, concerns and ideas they have. This will give you, and others that have concerns about an aging parent, the opportunity to present difficult facts and realities to a parent. This meeting can also give your parent the opportunity to present ideas from his or her own perspective. Consider including trusted friends or confidants of your aging parent to further relax the mood of this potentially difficult situation. Be sure that what this meeting is about is clear upfront; do not blind side your aging parent with an “intervention style” confrontation as this could create an air of mistrust from the outset.

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Legal Matters
Does your parent have a will, a living will, or any other legal documents made regarding end of life choices? As your parents age, and their mental capacity deteriorates, they may reach a point where they are no longer legally permitted to make their own decisions. If they don’t have certain legal documents in place before that point, you and your family could be in for significant heartache as you try to get your parents’ end of life choices honored.

If your parents have a set of legal documents regarding end of life choices, be sure to have those reviewed, and be certain you have documents that carry legal authority; this typically means you must have an original form of each document. If your parents don’t have any these “end of life” documents, consider meeting with an attorney to discuss preparing these documents as soon as possible.

There are many heartbreaking stories of parents who did not want to be maintained on life support, yet because the proper documents were not in order, family decisions wouldn’t be honored by a medical facility, and a difficult and stressful time became even worse.

Family Dynamics
When considering whether you or your sister will care for your parent, you must consider the following family dynamics:

  • Which sibling gets along best with the aging parent that needs to be cared for?
  • Which sibling has the most time, or other resources available to give?

In many situations where children are caring for an aging parent, one child takes on the lion’s share of the work, while other siblings may only contribute financial resources, or nothing at all, to the care. Before taking on such a weighty responsibility, you should meet as a family and identify all of the responsibilities you think will need to be met in order to provide effective care for your aging parent. From living arrangements, to doctor visits, to in-home medical care, to feeding and bathing to paperwork and phone calls. Allowing all of these responsibilities to rest on the shoulders of one person can be an unreasonable burden. Working together as a family to divide responsibilities can ease stress for everyone.

An idea to further reduce this potentially stressful and difficult situation is to have each child that will participate in the care giving process do so in the area where they will be most efficient. If one sibling works nights, and is typically available in the afternoons, he or she might be assigned to be with your parent for afternoon meals, and to drive him or her to doctor appointments. Maybe another sibling is more adept at paperwork and dealing with insurance companies and care agencies, so he or she could be the designated “paper and appointment person.” And since the youngest sibling was always your mother’s favorite anyway, and because the youngest has an abundance of patience, it may be best to have your mother stay with her while she recuperates.

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Career Decisions
When considering whether to care for an aging parent, you’ll likely have to take a look at your career and make decision that may have a lasting impact on you. If you’re in the midst of a career and are considering taking on the responsibility of caring for an aging parent, the following are some topics you should consider:

  • Career Advancement. Will you sacrifice years (or maybe decades) of advancement, if you take a period of time away from your career to care for an aging parent? Before you make a final decision, be sure to understand not only what time away from your career will mean for you advancement-wise, but also investigate your feelings about what your career advancement means to you. For some, self-worth and a sense of accomplishment are closely associated with career advancement. If you give that up at the same time you take on the stress of caring for an aging parent, you may create a difficult emotional situation for yourself. Ask tough questions, be honest with yourself, and don’t be afraid to discuss this topic with your loved ones and others in your field. The more information you can gain the more informed your decisions will ultimately be.
  • Fulfillment. Beyond the satisfaction that comes with rising through the ranks of your company, and taking on new and exciting responsibilities, for many in the workforce there is also an inherent love for the work they do. Are you a newspaper columnist that enjoys the work that goes into developing and writing a story that can impact many readers? Are you a designer or a teacher, waking up each morning excited about the new things you will create, and the minds you will inspire? Careers fill a role in many of our lives that go beyond just paying the bills, and if you are suddenly in a position where that “thing” you enjoy is gone, replaced by a new kind of stress that may not produce the same passion and joy, you may find yourself wanting to fill that void. Talk with as many people as you can about this potential impact. Investigate all options you have with regard to your job. If you are a teacher, maybe you move into a part-time or substitute role while caring for your parent, or even a team teaching arrangement. If you write for a local paper or a national magazine, maybe you will be able to continue your work on a freelance basis. Explore your options and do not underestimate the impact giving up a career, that brings you regular enjoyment, can have on you.
  • Income. Taking on the responsibility of caring for an aging parent will certainly impact the bottom-line of your household budget. You will have more food costs, more medical costs to begin with, and other ancillary costs will continue to pop up along the way. If you or your spouse is forced to resign a career position, it’s wise to run the numbers to see how that lost income will impact your family. The stress of caring for an aging parent can be overwhelming. Adding the stress and burden of a monthly strain on your budget will undoubtedly enhance the negative stress of your situation.
  • Benefits. Changing your status at your place of employment can lead to a reduction or loss of employment benefits. Depending on your current family situation, this potential loss of benefits can have a significant impact of your life. Medical costs can quickly drain even a flush savings account. So, before making the decision to give up job-related benefits, take a look at what your cost exposure will be for common medical circumstances for people in your age group.
  • Retirement. The longer you continue to add resources into your retirement accounts, the greater your potential return on those investments will be during your retirement years. In some jobs, 100% retirement plan vesting may take several years, and if you leave your job before that vesting takes place, you may be left with nothing. Additionally, after you turn age 50, you can make catch-up contributions to your 401k or IRA. Failing to fully fund retirement accounts can have painful consequences for you when you need to rely on those funds as a source of income. Ask questions at your place of employment to understand what the status of your retirement benefits is, and what will happen if you feel you need to resign to care for your parent. Additionally, find out if taking a leave of absence is an option for you, and what impact that might have on your retirement account.
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Logistics
There are certain logistics that must be planned to make sure the transition of a parent living on his/her own to having assisted care in some way is smooth. The following are some points to consider in this area:

  • Housing. Do you intend to bring your aging parent into your home? If so, what adjustments will you need to make to your home in order for it to be an appropriate fit? In some cases, the changes may be as drastic as a full home remodel to add a bedroom and handicap access bathroom on the first floor of your home. Or, the changes may be as minor as adding a few handles and lights here and there. The functionality of your aging parent will be a determining factor in many of the housing decisions you’ll have to make. If your aging parent will be staying with you, be sure to walk through living arrangements as well as day-to-day activities to ensure you have identified all areas where changes must be made. Also, be flexible when it comes to pictures, knick knacks and furnishings. Your aging parent has a level of comfort not just with his or her home, but with cherished belongings as well.

    If you intend to have your aging parent remain at his/her home, while you or another sibling provides care, the housing logistics can be a bit different. While there may be modifications required in order for your aging parent to safely maintain residence in his or her own home, you may have to make home modifications to accommodate you, or whoever the caregiver will be. Additionally, there may be other housing-related issues that pop up unexpectedly, so be sure to walk through how living arrangements will work, and what a typical day will look like.
  • Time. Planning how much time you, another family member or a caregiver will need to spend with your aging parent each day is an important part of the planning process. Depending on the function level of your aging parent, this could be around the clock care, or it could simply mean being available to help when necessary or requested. You must be honest about the condition your parent is in and realistic with what the time constraints will be.
  • Social/Activities. What did your dad like to do before his vision became so poor he could no longer drive? Was he active in social clubs or in church activities and service to the community? Did he attend sporting events or other events in his area? Are there resources within your community that can facilitate your dad continuing with his normal routine, in spite of the fact he can no longer get himself around? Are there clubs, services or community resources to provide your dad with a place to go during the day? Tapping into community resources to help keep your aging parent engaged in his/her typical lifestyle, while allowing you to continue the majority of your typical lifestyle, can go long way toward a successful caring relationship.
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Putting Your Plan into Action

Have you run all the numbers? Have you worked out the logistics of where your parent will live, and what needs to be done to get the home ready for him or her? Have you thought about what your professional life will look like while you care for your aging parent? If you have done the planning, and have had all the tough conversations, now it is time to put your care plan into action. Review these steps for consideration as a guide to implementing your care plan.

Move-In Date
The needs of your parents will likely have an impact on this date. If you’re dealing with an emergency situation, the move-in date may be something you have little to no control over. However, if you have a parent who had an accident, and is moving out of the hospital and back home on a certain date, you have a time frame to guide your planning and preparation. An even more advantageous situation is when you and your aging parent collectively decide it’s time for him or her to accept a more hands-on care plan in his or her life. In this situation you have the benefit of deciding how and when to begin your care plan, providing you with the ability to generate and implement a comprehensive care plan.

Parent Assets
If your aging parent has assets that need to be liquidated as part of your care plan, make a determination when it would be best to get this done. You’ll have to consider issues like potential tax consequences, market trends, termination penalties and time. Accumulated assets of your aging parent can have a positive impact on your care plan, but mismanagement of those assets, or mismanagement of the liquidation of those assets, can cause significant problems. This is an area where you may want to consider the professional advice of a financial planner, accountant and/or an attorney to ensure you are not only making good moves for the short term, but also moves that will maximize the financial resources you’ll have available to use in the care of your aging parent in the long-run.

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Gather Important Information
As soon as possible after the decision has been made to bring an aging parent into your home for care, you should begin working on gathering important documents and information. Creating a personal data record, essentially a database or file of important parental information, will make this already difficult transition smoother, and will facilitate efficiency in managing all of your aging parent’s affairs. Consider categorizing this personal data record into groups or sections. You could organize the data you collect as follows:

  • Medical
  • Insurance
  • Financial
  • Legal
  • End-of-Life

Some of the information you should gather and categorize includes such things as his/her social security number, date of birth, asset account information (including any passwords and login information). Additionally, be sure to collect life insurance policies, health insurance cards, Medicare and Medicaid plan numbers as well as the name, number and address of your aging parent’s doctors, dentist and pharmacy. Finally, you should have a list, with detailed usage instructions, for any medications your aging parent is currently taking, as well as a complete health history. If you are concerned about how to compile all of this data, there are online resources that can assist you in compiling all of this information in one easy to use location.

Budget
Having a budget on paper, and tracking actual income and expenses against budgeted numbers on a regular basis is a good way to determine if your cost projections are realistic, and to ensure that you are sticking to your budget. If you were diligent through the planning stage, it is likely you have considered many (if not all) of the potential cost variables. If you face market changes that significantly impact an income assessment, you should be able to quickly identify where budget shortfalls or windfalls will come, and that will give you the ability to adjust your plan accordingly. However, if you fail to have your care budget on paper, or you do not track income and expenses and compare those to your budget numbers regularly, there is a real possibility your numbers may be off significantly. If this is the case, you will most likely find yourself with a budget deficit rather than a budget surplus. So, be sure to plan ahead, plan in the middle and continue planning through the end of your time as a caregiver to ensure that lack of money does not add to the already stressful situation.  

Conclusion

Caring for our aging loved ones is a situation that has become a reality for many people over the last several decades. Careful planning, and diligently following that planning, is the best way to ensure your aging parent is able to experience happiness in spite of dealing with difficult circumstances. The same premise holds true for you the caregiver as well; the more prepared you are to handle the weighty responsibility of caring for an aging parent, the smoother this difficult task will be for you and your family as well.

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