Managing care for an elderly parent can be emotionally draining and logistically exasperating under the best of circumstances. I consider myself lucky because my mother, in her final years, was generally appreciative of the care my sister and I provided either directly or with the help of a series of home-care aides. She had her moments, but for the most part, my mom gladly accepted help.
Unfortunately, that’s not always the case with older people grappling with deteriorating health or mental function. Consider the case of Ed, whose health and cognitive abilities went into sharp decline after his wife died. His stepdaughter Jan jumped into the fray, quitting her job to help take care of her father, who suffered from diabetes.
“When his blood sugar spiked to a dangerous degree, Ed refused to go to the hospital,” writes Jody Gastfriend in a newly published book, “My Parent’s Keeper: The Guilt, Guesswork and Unexpected Gifts of Caregiving” (Yale University Press). “Jan, upset and alarmed, pleaded with her stepfather and eventually called 911 against his wishes.”
Soon, Ed had to have two toes amputated. Then a leg. “Although Ed was able to put on his own prosthetic, he refused to do so and was confined to a wheelchair,” Gastfriend reports. Compounding the challenges for Jan: “Ed would not agree to an outdoor ramp, making movement in and out of the house a Herculean task. He was stuck -- physically and emotionally. And so was Jan.”
Gastfriend has accumulated a wealth of knowledge about caring for the elderly based on both her personal and professional experience. She has been a social worker for more than 30 years and currently is vice president for senior care at Care.com, the leading online marketplace for home-care services.
In “My Parent’s Keeper,” Gastfriend examines all aspects of caring for an elderly parent, from dealing with difficult siblings to hiring professional caregivers to managing the financial burden. But she’s particularly insightful when it comes to dealing with the parents themselves – especially those who refuse to acknowledge they might need help after a lifetime of helping others. (If you want a sample, Forbes just published an excerpt of the relevant chapters.)
“One of the biggest frustrations for adult children is that they come up with a plan that makes perfect sense to them but their parent says, ‘Thanks but no thanks,’” Gastfriend writes. “When our parents’ refusal to accept help puts their safety and well-being in jeopardy, we feel compelled to act, yet our good intentions are often thwarted. I have heard countless stories of caregivers who tried strong-arming their parent to accept help – only to feel angry and dismayed when their efforts failed.”
Gastfriend has two simple but wise pieces of advice if you have a parent who clearly needs help but refuses to accept the fact. First, try not to take their rejection personally. It’s not you they’re rejecting, but the notion that they may not be as capable and independent as they once were. And second, try to empathize with their fears and insecurities. Literally, try to imagine being in their place and how you might react under similar circumstances. The exercise can help turn an adversarial process into a partnership.
“Offering choices and ceding a little control along the way may help break down the walls of resistance,” Gastfriend observes.
Sometimes all it takes is a change of terminology. Gastfriend cites the example of one family who initially had trouble persuading their father to accept help from a professional caregiver. The father, you see, was a retired corporate CEO who was not accustomed to relinquishing control. Wisely, his children stopped using the term “caregiver” and started saying “assistant” instead. That was enough to satisfy their father.
If, despite your best efforts, a parent refuses to budge, you may need to seek help from a professional, Gastfriend advises.
“Aging life-care professionals, elder-law attorneys and professional mediators can provide an objective perspective about financial and legal matters and lay out options for care. They may also dislodge entrenched parents from unreasonable and unsustainable positions that put them and others at risk.”
In an appendix to “My Parent’s Keeper,” Gastfriend distills her experience and insights into three useful tips:
One of the uglier conversations I ever had with my mother was over concerns my sister and I had about her driving abilities -- or lack thereof -- as she approached her 80th birthday.
Until she was 75, my mother commuted several times a week between her home in Highlands and her job as a journalism teacher at Fairleigh Dickinson University in Teaneck -- a long, difficult commute she often managed at night and in all kinds of weather. But when she began exhibiting what we later realized were the early signs of dementia, she started to lose her confidence behind the wheel.
My mother admitted that she sometimes felt lost when driving -- even close to home in areas she was familiar with. She increasingly asked me to drive her places rather than drive herself. She clearly was having difficulty staying focused on the road.
But when my sister and I suggested my mother stop driving, you’d think we had asked her to stop breathing! “What am I going to do without a car?” she said again and again. Not long after, my sister and I quietly gave my mother’s Subaru Forester to my sister’s daughter, who had just started driving. For months afterward, my mother would ask repeatedly, “Do you know where my car is?”
In retrospect, my sister and I could have handled the situation a lot better. What I didn’t know then is that a great deal of research and advice are available to help evaluate the driving skills of elderly people and then sensitively discuss the issue with them.
“Because driving is closely tied to freedom and independence, acknowledging the possibility of one day being unable to drive is difficult for almost anybody,” according to AAA. “This is why it’s important to prepare for a conversation about safe driving.”
AAA and AARP both offer valuable resources for family members concerned about loved-ones continuing to drive late in life. It’s important to keep in mind that just because someone is in their 80s or even 90s doesn’t mean they no longer can drive safely. On the contrary, data show that “seniors are safe drivers compared to other age groups,” AAA reports in the SeniorDriving section of its website. Senior citizens are more likely to wear seatbelts, observe speed limits and avoid drinking and driving.
But because people are living longer than they used to, seniors are “outliving their ability to drive safely by an average of 7 to 10 years,” according to AAA. What’s more, three-quarters of people who are 65 or older take medications -- many of which can impact driving performance.
“The average driver makes about 20 major decisions during each mile driven -- and often has less than one-half second react to avoid a potential collision,” according to AAA.
The automobile association has developed a self-assessment test to help seniors determine if their driving skills have deteriorated. The test seeks responses to statements like, “Intersections bother me because there is too much to watch from all directions,” and “My thoughts wander when I drive.”
Family members also should be on the lookout for tell-tale signs. Two common indicators that an elderly person no longer can drive safely:
AARP offers an online tool to help family members assess the abilities of elderly drivers. “How do you know when a bump is just a bump, or when it’s a sign that your loved-one should pull off the road for good?” AARP asks.
To answer that question, AARP asks family members to fill out an extensive questionnaire covering everything from the driver’s medical history and mental state to how well he or she performs a range of driving skills -- from starting the car to backing out of parking areas. After tallying the answers to more than 50 questions, the website spits out a driver-safety score.
AAA offers an interactive tool to help determine whether a driver’s medications are likely to impact his or her abilities. Simply type in the names of the medications and the website displays a slew of information about which drugs have the potential to diminish one’s driving abilities.
If the various assessments lead to the conclusion that an elderly person should no longer drive, then comes the difficult task of delivering the bad news. AAA offers a number of useful tips when it comes time to have “the conversation.” Among them:
I’ll never forget the feeling of confusion, frustration and fear when I first noticed that my mother, then in her early 80s, had begun showing signs of what used to be called senility – now commonly referred to as “cognitive impairment.” Suddenly she was having trouble paying her bills. She was too quick to say yes to anyone who called on the phone asking for money. She talked about her students at Fairleigh Dickinson as if she were still teaching, even though she had been retired for some years.
My sister and I weren’t sure how to react, in part because we weren’t sure whether our mother merely was slipping a bit mentally, as many people do late in life, or was in the early stages of dementia. Were the symptoms likely to get worse? How much time did we have before she would need help with everyday tasks? Was she at risk of hurting herself?
As we soon learned, our mother was, in fact, displaying early symptoms of dementia. And it wouldn’t be long before we would be forced to make some very difficult decisions about her long-term care – decisions that forced us to weigh her well-being against her limited finances. In retrospect, I wish we had consulted a professional earlier on to get a better handle on my mother’s condition and how it would likely progress.
For family members, the hardest part about dealing with an elderly parent or relative is interpreting – and responding to – early signs of cognitive impairment. To better understand the issues involved, I reached out to Dr. Jessica Israel, a leading practitioner of geriatric medicine. Among other things, she is the corporate chair of geriatrics at RWJ Barnabas Health and director of the James and Sharon Maida Geriatrics Institute. She also is a clinical associate professor at Drexel University’s College of Medicine in Philadelphia, and maintains a private practice affiliated with Monmouth Medical Center in Long Branch.
Dr. Israel graciously agreed to answer my questions about cognitive impairment.
Q: What are the early signs that an elderly person may be cognitively impaired?
A: The early signs sometimes go unnoticed. People experience what is called a lack of executive function. It’s how we plan our day, how we pay our bills. Maybe a person has been doing their taxes every year, but now they can’t manage it. Beyond that, it’s very common to see repetitive behavior, like asking the same question over and over. Sometimes it’s just a change in behavior, like retreating from social situations.
Q: If family members see some of these signs, what should they do?
A: They absolutely should have the person evaluated by a professional, preferably one with a medical background and experience working with elderly patients. It’s important to determine whether the symptoms are tied to some form of progressive dementia or were caused by a treatable illness. It’s not always Alzheimer’s disease. The most common example is depression. It can present initially with memory loss similar to dementia, but it’s ultimately a manifestation of depression, which can be easily diagnosed and treated.
Q: What types of professionals are most qualified to evaluate an elderly person for cognitive impairment?
A: A medical doctor or nurse practitioner. It could be a family doctor, neurologist or psychiatrist, but a specialist in geriatric medicine with a comprehensive practice will tend to have the most experience and resources. Sometimes we involve other types of professionals in evaluating patients and counseling families. For example, if a patient who is an 80-year-old woman and holds a Ph.D. in literature were to present with memory loss, I might refer her to a neuropsychiatrist for additional evaluation. It can be hard to make a diagnosis in patients with high levels of education using only simple office-based tools.
Q: What kinds of tests are performed to determine if an elderly person is cognitively impaired?
A: There are various tests we perform, including the Folstein test, the Montreal assessment and the Hamilton Depression Scale. We also sometimes order CT scans to see if the underlying cause might be a stoke or tumor. We also test for Vitamin B12 deficiency and hypothyroidism, which also can be associated with memory loss.
Q: What are the most common causes of cognitive impairment among the elderly?
A: If we rule out treatable causes, such as depression or vitamin deficiency, then we think about dementia as a diagnosis. Alzheimer’s Disease is by far the most common form, but there’s also vascular dementia, which might be related to a stroke or cardio-vascular disease. And sometimes Parkinson’s disease can lead to dementia. There are many different types.
Q: If it’s determined that an elderly person has dementia, how quickly can family members expect to see the symptoms worsen?
A: In most cases, dementia is a progressive illness. There are basically three stages of dementia, with a fairly consistent timeline. The early stage typically lasts 1-2 years, and often goes undiagnosed. The moderate stage is the longest, approximately eight years. This is when you may start to see behavioral changes. The advanced stage generally is the shortest, only 6-12 months. This is when the person can’t eat or walk independently, is incontinent, and has no meaningful verbal communication. Dementia usually spans about 10 years, start to finish. In early- and moderate-stage disease, it’s important that they be evaluated and family members begin planning for the future.
Q: If concerned family members decide to have an elderly relative evaluated by a professional, should they try to explain what they’re doing and why? Or is it better to avoid the issue and let the doctor or other professional explain the reason for the visit?
A: It’s a question of who the person is and how that person typically reacts to situations. And what kind of relationship you have with the person. Some people have some awareness of their condition and are okay seeking help. Others will absolutely reject the notion that they’re ill. It all depends on the individual and what kind of relationship family members have with that person. Being open and honest if possible, however, would always be my first choice.
Q: Assuming a positive diagnosis of cognitive impairment, what’s next?
A: We really talk to families a lot about safety. We talk to them about driving, which can be very dangerous. We talk to them about safety in the home, the kitchen, the risk of them walking off and getting lost. Should they be wearing a safe-return bracelet, with their name and address on it, or even a GPS bracelet that can help locate them?
Q: If an evaluation determines that an elderly person no longer is capable of living on their own, what are the options?
A: A comprehensive geriatric practice has social workers and other professionals who can discuss the full range of options with family members. There are a lot of day programs for the elderly that are great, where people can go and feel almost like they are going to work every day. There are nursing homes, of course, and that’s not necessarily a bad option, but it can be very expensive. There’s also assisted living. And there are home-care aides. It’s always great to be cared for in the comfort of one’s home. But there’s no one-size-fits-all. Every case is different.
The biggest challenge I faced in caring for my mother in her final years was finding a live-in aide who was trustworthy, compassionate and compatible with my mom. Oh, yes, and affordable.
I met a few women who had solid experience as live-in aides but lacked warmth. I met a few others who were quite caring but clueless. And I met one or two who seemed kind of perfect but wanted too much money.
I employed nearly a dozen live-in aides over the course of two years – some who worked for agencies, some of whom I hired directly – but I’m not sure I ever found the right fit for my mom. In retrospect, the reason for this is quite simple: 1.) The job of working as a live-in aide is extremely difficult; and 2.) There aren’t enough men or women (mostly women) who are both willing and available to do the work.
Consider the statistics in a report that consulting firm Mercer released last month, as reported by Home Health Care News. The number of new job openings for home-care aides is projected to grow by a third to 423,000 by 2025. And because the number of elderly Americans in need of home-care services also is growing rapidly, Mercer forecasts a huge shortage of aides. How huge? Nearly 450,000 by 2025.
The shortage will be worse in some parts of the country than in others. Indeed, a number of Midwestern states are seen as having a surplus of home-care aides. But not New Jersey. The Garden State is among about 10 states, including New York, Pennsylvania, and Massachusetts, forecast to have the most severe shortages.
The situation isn’t all that hard to grasp once you understand the reality of working as a home-care aide – particularly those who are hired to live with the client. Live-in aides like the women who took care of my mother spend weeks at a time isolated from their friends and family, typically taking a few days off a month. They have to be on guard 24/7 in case the client falls or wanders off. And if the client suffers from dementia, as my mother did, the aide may be summoned at any hour of the day or night for no apparent reason.
New Jersey Monthly magazine recently assigned a reporter to shine a light on the largely hidden world of home-care aides. The article, "Home Health Aides Are a Vital Force for New Jersey’s Most Vulnerable," captures the difficult challenges home-care workers face – and the dedication many of them bring to the job.
“Aides sleep in back rooms and on sofas, lightly, in case their charge wakes up in the middle of the night to use the bathroom,” wrote author Tina Kelley. “Sometimes they don’t get any rest at all.”
Some of the aides interviewed for the article said their clients treated them poorly. “Some clients … are overtly racist; other clients and their families treat the aides as though they don’t exist.”
My business partner, Donna, and I experienced this first hand with one of our earliest clients at Twin Lights Home Care. Several aides who took care of the client, a woman in her 80s, complained about being ignored or belittled whenever the woman’s grown sons came to visit. Complicating the situation was the fact that the men had a strained relationship with their mother.
Despite the hardships, most home-care aides earn low wages. How low? According to New Jersey Monthly, the average is just $23,000 a year.
My experience has taught me that a trustworthy, thoughtful, compassionate home-care aide is worth her weight in gold. That’s why my partner and I do all we can to show our respect and appreciation for the aides who serve our clients – from providing living wages to scheduling relief when they need it, to doing little extras like giving them bonuses at Christmas and on their birthdays.
If you need to hire a home-care aide and want the assistance of an agency, be sure to ask them a few important questions up front:
The other option is to hire an aide directly. But as the above-cited statistics make clear, that’s becoming increasingly difficult to manage. If you do find an aide you like, my advice is simple: Treat her with kindness, dignity and respect. You’ll get all that, and more, in return.
Written by T.J. Foderaro
Rep. Frank Pallone, who has represented parts of Monmouth County in Congress for 30 years, has drafted a bill that would provide welcome relief for families caring for elderly relatives. The legislation, titled the Medicare Long-Term Care Services and Supports Act, would expand the Medicare program to help cover the costs of long-term care – including in-home care.
Significantly, the congressman proposes reimbursement for services provided not only by professional caregivers, but also by family members themselves. Pallone faces an uphill battle, to be sure, but the language of the bill recognizes an important fact about elder care that rarely gets acknowledged: Caring for an elderly parent or relative puts a tremendous strain on family members – not only emotionally but also financially.
The exorbitant costs of long-term care are well documented (click here for a previous blog post citing various studies and statistics.) What’s not as well understood is the financial impact on family members who help care for an elderly parent or relative. A recent study by insurer Northwestern Mutual sheds some much-needed light on the subject.
A survey of more than 1,000 caregivers found that while about half said they were ill-equipped to provide financial support to an elderly relative, two-thirds drew on their own limited resources to do so. Indeed, a third said they spent at least 20% of their monthly budget on caregiving-related expenses such as food, medicine and transportation.
“There’s an alarming financial impact from being a caregiver,” said Kamilah Williams-Kemp, vice president for long-term care at Northwestern Mutual. “For some people, those costs can take up a lot of their financial budget.”
According to the Bureau of Labor Statistics, about 41 million Americans, age 15 or older, provided unpaid eldercare from 2015-2016. Nearly half of the survey respondents said they took on their roles as caregivers suddenly and unexpectedly.
“If caregivers haven’t planned ahead of time, they end up making some rash decisions about how to absorb their caregiving costs … like withdrawing from savings and working more,” Williams-Kemp said. “Those can have long-term repercussions for the caregiver.”
And it’s not just the money. Caring for an elderly person who is physically challenged or cognitively impaired can take a very real toll on the caregiver’s relationships and lifestyle. Consider these other findings from Northwestern Mutual’s study:
The bottom line: Caring for an elderly parent or relative is hard work, requiring real sacrifices in time and money. Compensating family members for those sacrifices is a key element of Pallone’s proposal to expand the scope of Medicare. (Click here for the complete text of the bill or here for a section-by-section summary prepared by Pallone’s office.)
Currently, Medicare provides very limited coverage for long-term care – namely, for individuals recovering from a serious illness or injury in a rehab facility, including a nursing home. But the benefit runs out after 100 days. And there’s no benefit for in-home care of any kind. In many cases, elderly people requiring the services of in-home nurses or aides are forced to exhaust their life savings in order to qualify for Medicaid, which then can be used to cover the cost of a nursing home.
“Today, a senior will spend an average of $140,000 in out-of-pocket costs on long-term care, and more than 15% of seniors will incur costs in excess of $250,000,” according to Pallone’s office.
In a statement released earlier this month, Pallone said: “The growing need for long-term care is one of the greatest threats to retirement security for American seniors, and the adult children who care for them. It’s time to expand Medicare to include a long-term care benefit so that millions of seniors and individuals with disabilities no longer have to face financial ruin before they get assistance.”
Among the highlights of Pallone’s bill:
I’ve been following Pallone since my days as a cub reporter at the Asbury Park Press, when he was still a member of the New Jersey Legislature. I’ve always found him to be a straight shooter – a politician who is more concerned about solving problems for his constituents than scoring points with ideological purists. But it’s doubtful such a bill can advance in the current political climate.
If nothing else, Pallone’s proposal should stimulate much-needed debate about how the country takes care of its rapidly growing population of senior citizens. Consider: There are currently 48 million seniors in the United States, according to the Census Bureau, including 1.3 million in New Jersey. By 2060, the nationwide total is projected to more than double – to 98 million.
Written by T.J. Foderaro
My sister and I had a big advantage when it became clear to us that our mother, then in her early 80s, no longer was independent enough to live on her own: We were great friends.
As our mom became increasingly forgetful and confused, my sister and I were confronted with a dizzying number of questions: Can anything be done to treat her condition? Does she need to go into a nursing home? What can we do to keep her in the home she loves? Does she need help right away, or can we wait a while? Does she have enough money to pay for the services she’ll need? How do we explain all of this to her?
Our mother’s dementia also confronted us with the painful reality that she was slipping away from us. Needless to say, it was a chaotic and emotional time for my sister and me, who also were juggling busy careers and families of our own.
If my sister and I hadn’t been close friends – if we didn’t see eye-to-eye on most things – I’m not sure how we would have gotten through that difficult period. If there’s one thing I learned caring for my mother in her final years, it’s the importance of communication among family members and friends.
A mountain of research and professional advice support this idea. A Place for Mom, a national agency that offers advice on senior living, warns that caring for elderly parents can lead to conflicts between siblings and other family members – which can make the job at hand a great deal more difficult.
“As elderly parents begin to rely on family for more support, the amount of conflict between adult children can increase. Dealing with a parent’s care can rekindle sibling rivalries that have lain dormant for years, and the discord can tear families apart.”
That may sound extreme, but many experts agree. One organization, the Family Caregiver Alliance, goes so far as to suggest that “a drink may make everyone more comfortable and more able to talk.” But, of course, “overconsumption should be avoided.”
Columnist Jim Zientara, a financial advisor who often writes about issues facing the elderly and their families, says caring for an aging parent or relative can put tremendous strains on family relationships. “One sister may live miles away and pay next to no attention to the parent, yet demand things be done her way instead of letting the local sister do what she feels is best,” he writes.
And make no mistake, he adds: It’s usually women who bear the brunt of the burden.
His advice: “Encourage open communication with your family to figure out ways to share the financial, emotional and time burdens. Hold regular meetings on the telephone or via email to discuss issues, set priorities and delegate tasks.”
Most experts agree that holding a family meeting, preferably in person, is an essential starting point. I remember meeting my sister for dinner in Red Bank after we visited our mom at Riverview Medical Center early on in the process. Those two hours we spent alone, uninterrupted by children or other distractions, allowed us to connect emotionally and share ideas about what to do next.
The Family Caregiver Alliance offers a comprehensive “how-to” guide on planning and conducting a family meeting. “When taking care of an elderly parent or another relative, family members need to work cooperatively,” the alliance notes.
Holding a family meeting is key to getting everyone on the same page. Although it may sound simple, organizing a constructive meeting that produces results is harder than you might think. To start with, who should be invited?
“In some families, only a husband/wife and their children are considered family. In other families, aunts, uncles, cousins, current and ex-in laws, and close friends may be included in the definition of family. When planning a family meeting, it is important to include everyone who is or will be part of the caregiving team.”
Then there’s the question of whether to include the elderly parent or relative who is the subject of the meeting. That will depend on his or her mental state. Elderly family members “usually do not want to be excluded from family events, and their preferences for care must be considered. However, if someone has dementia or another condition where he/she might misunderstand the purpose of the meeting, it might be appropriate to hold at least the first meeting without him/her present.”
If certain family members have trouble getting along or communicating, the alliance recommends engaging the help of an outside facilitator. This could be a priest or minister, family doctor, psychologist or social worker.
The next step is to draw up an agenda – yes, an agenda. Just as in the business world, a family meeting will be much more fruitful if there’s a list of priorities to guide the discussion. An agenda might include some or all of the following topics:
In many cases, such meetings will bring out long-simmering tensions and conflicts among family members, possibly triggering emotional outbursts and hurtful comments. That’s why the alliance suggests not trying to pack too much into the first meeting, and instead plan on holding a series of meetings. Even if some family members can’t physically attend each meeting, they can listen in remotely or get briefed later on.
“Remember that you can’t resolve long-standing family issues with one such meeting. The task is not to ‘fix’ the family, but rather to have everyone on the same team, as much as possible, in caring for someone who is ill.”
A final piece of advice from the alliance: Memorialize decisions made in the meeting by writing them down and sharing copies with all family members. This will help keep everyone focused on achieving the main goal: ensuring that an elderly parent or other relative receives the comfort, support and love they deserve in their final years.
Written by T.J. Foderaro
I’ll never forget the time I gently suggested to my mother, then in her late 70s, that she didn’t need a third (or was it a fourth?) glass of wine. If looks could kill, I would have predeceased her by five years.
For my mother, wine was one of life’s simple but essential pleasures — up there with cigarettes, butter and The New Yorker magazine. Every evening, usually between 5 and 6 p.m., she’d fetch a goblet from the cabinet, deposit a couple of ice cubes and fill the glass with pinot grigio. Typically, she was on her third glass by 8 p.m. And if she had company, there might even be a fourth, possibly a fifth.
As a wine lover myself, I never begrudged my mother her nightly tipple — until age started to catch up with her. As she became less steady on her feet and less focused mentally, it dawned on me that even a moderate amount of wine could make her more susceptible to a fall — or worse. What if she forgot to lock her door before bed? What if she forgot to turn the oven off?
Thus it happened one night, with little forethought on my part, that I blurted out something to my mother about having had enough wine. This led to a discussion that quickly escalated into an argument that exploded into a brief shouting match — one of the few times I raised my voice to my mother. By that time, she’d forgotten about pouring herself another glass of wine. I apologized.
As time passed, I found myself challenging my mother on a range of decisions I had never previously questioned. “Did you really mean to give $250 to a local charity?” “Don’t you think it’s time to stop driving?” “What do you mean you want to get a dog?” Such questions irked my mother. Her reactions ranged from hostile stares to exclamations of, “It’s my money!”
In retrospect, one of the most difficult things about helping my mother “age in place” — that is, continue living in her own home — was constantly navigating the boundaries between proper concern for her safety and being a perfect pain in the ass. My efforts to control my mother’s behavior, however well-intentioned, were extremely frustrating for her. And it led to strains in our relationship.
Finding the right balance between what’s responsible and what’s meddlesome is the subject of an excellent article in the Wall Street Journal titled, “Who’s in Charge Here? Aging Parents Resist Interfering ‘Helicopter’ Children.” We’re all familiar with “helicopter parents” — those who try to micromanage every aspect of their kids’ lives. But as our parents grow older and less independent, there’s a tendency among their children to become “helicopter kids.”
Joshua Coleman, a psychologist who specializes in family dynamics, says there’s a fine line between being “an appropriately concerned adult child and an overly worried helicopter" child. “If a parent is in an accident, it might be time to talk about driving,” he told the Wall Street Journal. “But if Mom doesn’t want to wear a hearing aid, it might be wise not to nag. Maybe she doesn’t want to listen to anyone at the moment.”
William Doherty, a family therapist and professor at the University of Minnesota, believes adult children need to ask themselves whether they’re intervening for their parents’ well-being or to alleviate their own worries.
“If your 80-year-old father is still driving, you worry” — even if he is capable of driving, Doherty said. “If he is not driving, you don’t worry, but your father has had a big loss.”
The Journal article quotes a Harvard University psychologist who observes, wisely, that even small, well-intentioned acts can send the wrong message to parents. “If a parent fumbles with the key when trying to unlock a door, kids should be patient and wait, rather than grabbing the key and taking over,” advises Dr. Ellen Langer. “While you may be trying to be helpful, the message, deliberate or not, is that you are competent and the parent isn’t.”
David Solie, an expert in geriatric psychology, cautions adult children against trying to make sure everything is perfect. “Don’t point out everything that they forgot, or that they aren’t as clean as they used to be,” he said. “Cut them some slack. If they want to date, don’t stand in the way. “Allow them to be happy.”
Another expert, Laura Carstensen of Stanford University’s Center on Longevity, offers sound advice for striking the right balance with aging parents: “Unless a parent is cognitively impaired and not aware of the level of his or her impairment, children need to respect the parent’s decision.”
Of course, gauging whether or not an elderly person is cognitively impaired – and to what extent they’re aware of the impairment – is no simple matter. That will be the subject of a future blog post.
Written by T.J. Foderaro
For 15 years after my father died, my mother managed her finances without a hitch. She had been educated at a top woman’s college and continued to teach at Fairleigh Dickinson University in Teaneck until her late 70s – driving 100 miles round-trip up and down the Garden State Parkway, rain or shine or snow.
Then one day she confessed to me that she no longer felt comfortable handling money, paying bills or managing her investments. My initial reaction was one of disbelief. I’d never known a smarter, more capable person – woman or man. But after reviewing her checkbook and discovering a pile of late bills, I realized she was right.
She asked me to contact the branch managers at two local banks where she had accounts, her investment advisor at TIAA, her attorney and the manager of her condominium building in Highlands. I found them all to be very forthcoming with information and advice. The reason for this only dawned upon me later: Years earlier, my mother had signed a power-of-attorney (POA) that authorized my sister and me to act on her behalf when she no longer was capable of managing her own affairs.
The POA proved a godsend, allowing me to cut through red tape and quickly get a handle on my mother’s finances. In retrospect, I’m very thankful she had the foresight to establish power of attorney.
But what, exactly, is a POA and how does it work? Are there any risks? How much does it cost?
For answers, I turned to Dana A. Bennett, an attorney with offices in Red Bank and Lakewood. Bennett, who has degrees from Villanova, Seton Hall and New York University, has been practicing trust-and-estates law for more than 20 years. Her credentials include chair of the Monmouth County Probate Committee and past president of the Estate and Financial Planning Council of Central New Jersey. She lives in Marlboro with her husband and two daughters.
Q: What does “power of attorney” mean?
A: A Power of Attorney (POA) is a legal document in which the principal (i.e., the person executing the POA) appoints an agent to assist with the principal’s financial affairs. The POA can be drafted to be effective immediately or conditioned on the principal’s incapacity. The POA does not strip the principal of any power; it merely enables someone to help with financial matters if the principal so desires. The agent under a POA has a fiduciary duty to act in the principal’s best interest.
Q: Who needs to consider setting up a POA?
A: Everyone 18 years of age and older should consider setting up a POA.
Q: What are the potential consequences of not having a POA?
A: If a person becomes incapacitated and does not have a POA, then a family member or friend must file a court action seeking legal guardianship over the person in order to pay the incapacitated person’s bills and handle their finances. The cost of a typical guardianship proceeding is several thousand dollars. Spouses do not have an automatic right to access each other’s financial accounts.
Q: What advice can you offer when it comes to choosing an individual to serve as a POA?
A: The person you appoint as your agent under the POA should be someone you trust implicitly with your money. The agent should also be someone who is well organized and would have sufficient time to devote to your financial affairs.
Q: Does a POA grant unlimited power to make decisions on behalf of an elderly person, including financial decisions?
A: Most POAs are very broad and allow the agent to do anything financial-related on the principal’s behalf. However, it is possible to sign a “limited” POA. A limited POA, for example, might give the agent access to one particular bank account.
Q: What steps are involved in setting up a “POA”?
A: Since a POA is a legal document with serious implications, prudence dictates that you see an estate-planning attorney to prepare a POA.
Q: How much does it cost to draft and finalize a POA?
A: While attorney fees vary, the typical cost is $175-$250.
Q: Once a POA is finalized, can it ever be amended?
A: You can revoke or amend a POA at any time as long as you are deemed competent. If you make any changes, you should immediately notify the agent under the POA and any financial institution that may have been given a copy of the POA.
For more information about setting up a POA, Bennett can be reached at 732-268-7520. Her website is www.bennettwyatt.com.
A few years before my mother passed away, she asked me to take over her finances. She had become increasingly forgetful and fuzzy with numbers, and she was afraid she might make a costly mistake. I was glad to help out.
One of the first things I discovered was that my mother was very generous with her money. She frequently donated to a number of causes -- from political action committees supporting women candidates to animal-rights groups to law-enforcement organizations.
When I asked her why she gave to certain groups, she answered, “Oh, they’re always calling for money.”
That led to a conversation with an aide we had hired to help take care of my mother. The aide told me my mother often received calls from people asking for money -- in some cases from people who sounded suspicious. I could feel my blood start to boil.
Ironically, even as the aide and I were discussing this out of earshot of my mother, the phone rang. My mother took the call. I listened from the other room as she answered a series of questions. After a while, my mother yelled to the aide to fetch her pocketbook.
“Why do you need your pocketbook?” I asked.
“He needs my credit card,” she said.
“Who? For what?”
“I’m not sure.”
That was enough. I asked my mother if I could talk to the man and she handed me the phone.
“Who is this?” I asked.
The man mumbled something and asked me who I was.
“I’m her son,” I said.
I never did find out who that was on the phone, what they wanted, or whether they represented a legitimate business or charity. My mother wasn’t sure either.
But such incidents became increasingly common as my mother grew older and lost her edge mentally. Before I took over her finances, it wasn’t unusual for her to write a check to the same organization two or three times in a month. And she once received a large package from a company that sells expensive emergency-alert systems for the elderly.
“Did you order this?” I asked her.
“No, I don’t think so,” she answered.
After many hours on the phone, I finally got the company to take back the equipment. But they refused to refund more than $500 that had been billed to my mother’s Visa card.
My mother was fortunate. The amounts of money she misspent or misplaced were relatively small. Many other elderly women and men aren’t nearly so lucky.
The Daily Item, a Massachusetts newspaper, recently published an excellent series on elder abuse, including financial abuse, that detailed a number of horrifying cases.
One involved a retired reverend who took a call from a man identifying himself as a San Diego police officer. The reverend, 78, was told his grandson was being held in jail and that it would take $43,000 in cash to get him out. The loving grandfather mailed the cash -- only to discover later that it had been a hoax.
Another case involved an 85-year-old woman who became friendly with a worker at a local senior-services agency. Over time, the agency employee persuaded the elderly woman to change her will, naming her as a beneficiary. She also helped the woman take out a home equity loan, then pocketed the proceeds.
“Elder victims of financial exploitation have lost homes, pensions, life savings, had utilities shut off, and suffered other financial hardships,” the newspaper report says.
According to Consumer Union, publisher of Consumer Reports, some 500,000 elderly Americans lose up to $36 billion annually due to financial abuse. Among the most popular scams, according to the National Adult Protective Services Association, are callers who say you’ve won a sweepstakes but first must send money to cover taxes; home-repair cons in which a scammer promises to do work cheaply, then disappears with your money; fraudulent fund raisers who solicit donations for ostensibly good causes; and individuals posing as utility workers who knock on your door looking to steal items from your home.
The protective-services association repeatedly reminds senior citizens that as a matter of policy, lottery agents, police and the IRS never call to ask anyone for cash. The association urges people not to give out information to strangers -- particularly bank account, credit card, and Social Security numbers.
The best way to prevent financial abuse of the elderly is for their children or other relatives to get involved. The newspaper series on elder abuse recommends family members take the following steps:
John Wasik, a personal-finance columnist for Forbes magazine, has written frequently on the topic of financial abuse of the elderly. “The best weapon in the fight against elder financial abuse is vigilance,” he wrote in a recent column. “Have a family meeting ... to discuss how to best protect a loved one.”
Wasik recommends talking to older adults about assigning power of attorney to younger family members before it’s too late.
“At a certain age, your older relatives will be unable to do things like pay bills or monitor their investments,” Wasik says. “It’s a natural consequence of age and cognitive decline -- and they may be suffering from dementia. I recommend that more than one person in a family be granted power of attorney.”
What exactly is power of attorney? How does one establish it, and how much does it cost? In my next blog, I’ll put these and other questions about power of attorney, or POA, to Dana Bennett, a Red Bank attorney who specializes in estates-and-trusts law.
Written by T.J. Foderaro
A recent study by the giant accounting firm PwC looked at elder-care insurance claims in an effort to gauge the enormous cost of long-term care (LTC). Bottom line: The average lifetime cost is $172,000. For the top quartile of policyholders who spent the most on long-term care, the average was $240,000 – nearly a quarter of a million dollars. (See previous blog post for more on the sky-high cost of elder care.)
It’s no wonder rates for long-term-care insurance have risen sharply in recent years. Does an LTC policy make sense for you or a loved-one? Do the upfront costs justify the potential benefits?
To get answers, I contacted Toby Stark, president of Stark Associates, an insurance agency in Tinton Falls. Stark has been in the insurance business for nine years, offering a range of coverages including LTC.
Stark graciously agreed to answer my questions about LTC insurance:
Q: What kinds of services are covered by long-term care (LTC) insurance?
A: Services include assistance with your activities of daily living (ADL) at home. Typically, an aide will visit your home (2-3 hours per visit) to help with dressing, bathing, preparing meals and similar household chores. Alternatively, insurance will cover a semi-private room in a facility.
Q: There have been news reports that the cost of LTC insurance has risen dramatically in recent years. Why is that?
A: The reports are accurate. Many carriers have left the market. Originally, rates were very competitive. As with any insurance policy, when utilization increases, the insurance carrier must increase the cost to either the current or new policy owners, leading to more expensive plans. Meanwhile, the cost of care has increased very rapidly, resulting in coverage that could be out of reach for the consumer. Home healthcare today, full time, could cost $75,000 per year. A semi-private room could cost up to $325,000 per year.
Q: What are the main factors insurers consider in pricing long-term care policies?
A: If you are looking to enroll in a traditional LTC policy, your current health plays a big part in being covered. Also, the carrier will make sure your mind is sharp and there are no signs of dementia. Even after that, only about 50 percent of those who apply actually get a policy. Life insurance with an LTC rider has more liberal underwriting.
Q: Are there flexible policies that cover one or both spouses in a household?
A: Generally, the policies are flexible. They are built for a couple to enroll, and offer as much as a 40% discount if both enroll together.
Q: Roughly how much might a 60-year-old woman in reasonably good health expect to pay for LTC insurance? How about an 80-year-old?
A: Depending on the individual, a 60-year-old could expect to pay $3,000 to $4,000 a year. An 80-year-old could expect to pay $12,000 a year or more.
Q: What can be done to keep costs down?
A: There are ways to keep costs down. I tell my clients only purchase what you can afford. Do not buy a policy that covers all your cost of care. Take out a policy that covers a good amount of your LTC bill, but not all of it.
Q: Are there policies that offer fixed premiums similar to term-life insurance? Or do the premiums increase every year?
A: Traditional LTC policies can change to increase costs if the carrier decides to do so. Life insurance with an LTC rider would be a fixed cost with no fluctuation.
Q: At what age would you recommend people consider purchasing long-term care insurance?
A: Ideally, the purchaser should be 55-62 years of age. Family history is a powerful tool, but there is no such thing as “family future.” If you have money and assets and would like to protect them, the smart choice is to buy coverage in that age range. Don’t wait until it is unaffordable and you are uninsurable. If not protected, you can kiss good-bye any savings you had.
For more information, Stark can be reached through his company’s website at http://www.stark-associates.com/.
Written by T.J. Foderaro