Aging Parents And Longevity: The Big Issue That Affects Families And How To Fix It

by Carolyn Rosenblatt

So often, we hear about folks declaring that they’d like to live to be 100. Most of us are probably more likely reach the average life expectancy of a little over 78 years for men and about 81 years for women in the U.S. In places where excellent healthcare is available more people surpass average life expectancy and more often reach their 90s and beyond. Is this a great thing?

stubborn old man

AgingParents.com

It’s time for a reality check. Longevity in aging parents can be wonderful but it can also be very difficult to manage.

Take the case of Bertrand, age 91, well fixed financially. He is confused but still driving around and participating in some activities. He loses track of his bills. His memory is shot. He can’t take care of his bedridden wife, but he hires helpers and they take advantage of his confusion. His only son, Dominic, lives an hour plane flight away but he has his own family and his own problems and can’t be available at every moment. Bertrand authorized Dominic, to be his agent on his Durable Power of Attorney to help with finances. When his son tried to step into one of Bertrand’s messes, Dad pushed him away and said he would not allow it. What is Dominic to do?

The burden on Dominic is overwhelming. Of course he wants his dad to have a long life, but now that creates problems he never thought about. He sees his father showing signs of dementia, but Bertrand refuses assistance with the very thing most needed: managing money. That leads to the danger of Bertrand’s assets being depleted, as no one is keeping track of them. Dominic called his father’s estate planning attorney to ask what to do.

His attorney can’t make Bertrand honor the Durable Power of Attorney he signed, as anyone can revoke such a document as long as one is still competent. Bertrand is at the last edge of competency to handle money but he’s too stubborn to admit it. And he’s also too stubborn to give up control and allow his son to help him.

Is there a way out of this dilemma? Perhaps. Bertrand’s physical health is fragile, as he has numerous diagnoses and goes to his doctor often. Dominic also is appointed on his father’s Advance Healthcare Directive, which gives him the opportunity to speak to Bertrand’s healthcare providers. He can call the main treating doctor and explain the situation. The estate planning lawyer told Dominic that with a letter from that doctor stating that Bertrand is incapacitated for managing his finances, Dominic can take over the family trust even if his Dad doesn’t want him to do so. That’s how the trust was written. Now Dominic has to get the letter and break the news to Bertrand, which is likely to set off a firestorm from Bertrand. Dominic knows that taking this next step is the only way to keep his parents’ finances safe. He is at least in good position that he just needs one letter from dad’s treating doctor to move forward to protect his dad.

Diminished financial capacity is an issue many adult children face with parents who live to be 90 and more. Mental capacity to manage money may not last for an entire lifetime, no matter how good an aging parent was at this before. At times, the children have to take over against the elder’s wishes. Some estate planning attorneys correctly predict this possibility and make the trust language easier to work with when a parent has to be removed from the position of authority. Other lawyers put horribly burdensome language into the trust, almost forcing the adult children to go to court in a pitched battle between parent and child when the parent is cognitively impaired. Here at AgingParents.com, where we mediate family conflicts like the one between Bertrand and Dominic, we see the dangers of badly written trusts. What does your parents’ trust say about possible incapacity? It is well worth a discussion!

Here are some points to find out about and correct if you need to do so.

1. If your aging parents have a trust, invite a discussion about what would happen if a medical condition rendered an aging parent unable to competently manage finances.
2. Look at the trust language about “incapacity”, a legal term. It is typically defined in the trust. If it says anything that necessitates going to court to have a judge say the person is “incapacitated”, that’s a red flag for bad trust language. Who wants to take a parent with dementia to court for all the world to learn that he or she is incapacitated? I don’t know what my brethren lawyers are thinking when they put this stuff into a trust!
3. Dementia is a real risk to every older person. No one gets it overnight and it’s common to not understand that one is actually impaired. That is the danger: it impairs money management along with lots of other things. Any trust should contain way to remove an impaired, unaware parent from managing the trust (assets, cash, etc.) in a way that is private, and does not require two doctors, going to court, or other dreadful burdens on the ones who need to remove an aging parent from the seat of control.
4. Ask your parents what they would want if a situation like that of Bertrand and Dominic came up. Ask them to imagine that they had to step down but couldn’t understand why and that the adult child had to legally remove them. Look at their trust with them and dig into the piece about incapacity, and “removal of trustee”.
5. If your aging parents have a trust with burdensome language in it about incapacity, ask them respectfully to consider your responsibility and have that trust fixed (“amended”), to lessen the burden that might happen to you. That means going to an estate planning lawyer and revising that language.

Notice that what Dominic needs to do with his father is directed by the words a lawyer put into legal documents for Bertrand. It is worth the effort now for you to find out what might be your responsibility in the future and see that it is workable for all in your family. Getting a trust amended (changed in this particular limited way) is generally not a long nor expensive task.

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Aging Parents And Longevity: The Big Issue That Affects Families And How To Fix It

Will You Be Responsible For Handling Your Aging Parent's Finances In The Future?

Are YOU the one appointed? For older parents who have done estate planning, most have appointed someone to handle finances and business matters if they become incapacitated for any reason. The Durable Power of Attorney (DPOA) is the legal document that makes this assignment. Would you know what to do if the responsibility for handling their money suddenly fell on you?

Are you appointed to take over finances?

The DPOA document itself is surprisingly easy to get. One can download it free from the internet. It has to be notarized, but that is just about the only formality required. A lawyer is not needed to draw one up unless special considerations exist. The court does not supervise what happens to the document. As you can imagine, this extremely powerful tool gives the assigned person the right to do just about anything with someone else's money. In the right hands, it is excellent protection from wrongdoing or mistakes by an incompetent elder. In the wrong hands it is a license to steal. Anyone can benefit from some guidance on what you can and can't do as the agent for another in this financial role. The appointed person is called an "agent", "attorney in fact" or "fiduciary".

The Consumer Financial Protection Bureau, a Federal agency, offers free booklets for those who must take responsibility for finances for another person: Managing Someone Else's Money. More than 1 million Managing Someone Else’s Money guides have been distributed since their release in 2013. Further, as laws about being an agent under a DPOA vary from state to state the Consumer Financial Protection Bureau has created six state-specific guides for Florida, Georgia, Illinois, Oregon and Virginia and most recently for Arizona.

Each guide contains information on the agent’s responsibilities and tips on how to spot financial exploitation and avoid scams. Also, each guide includes a “Where to go for help” section with a listing of relevant agencies and service providers. The guides are not intended to provide legal advice. When there is doubt about using such a document, there is no substitute for competent legal advice.

All that said, how does this agent concept apply to YOU? If you already know that your aging parent has designated you to fill this role if and when the time comes, be ready. You will need to know where your parents' financial assets are located. Which banks or financial institutions do they use? What passwords and account numbers are available? Here at AgingParents.com, where we encounter families with incapacitated or partially incapacitated elders quite often, we find befuddled adult children who have never asked their aging parents where the money is and how to access it. When a health crisis such as a stroke or heart attack happens and their loved one can't answer any questions, someone still has to pay the bills for the incapacitated person. The unprepared adult children may end up using their own resources to fill the gap until the parent recovers sufficiently to give them the information they should have had long ago. And some parents don't recover sufficiently to even do that.

Here are the takeaways:

1. If you aren't sure whether your aging parents (retirement age and up) have signed a DPOA, find out. If one does not exist, do persuade them to get it done.
2. If a change is needed on this critical document, such as the appointee turning out not to be honest or not available, ask your parent to sign a new and updated one. Get legal advice as needed.
3. If you are the person appointed as agent, work on getting the information you would need if you had to manage their money in a crisis, such as a hospitalization. Get account numbers, passwords, checking account location, financial institutions they use, etc. Don't be left in the lurch if you end up having to take responsibility.
4. Download your booklet, Managing Someone Else's Money so you can know what to do and know how to spot scams that could endanger your loved one.

Preparation now can save you a lot of stress later.

Carolyn Rosenblatt, RN, Elder Law Attorney, Healthy aging and protecting our elders, AgingParents.com, AgingInvestor.com

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Will You Be Responsible For Handling Your Aging Parent's Finances In The Future?

Families Spend More To Care For Their Aging Parents Than To Raise Their Kids

It costs families more to care for a frail older adult than to raise a child for the first 17 years of her life. Yet, while the government routinely provides a broad range of assistance and free services for children, it offers only limited benefits for those needing long-term supports and services—and mostly only for those who are impoverished and very ill.

The other day, the federal government released a headline grabbing report: The average out-of-pocket cost of raising a child from birth to age 17 is about $234,000. Among families where an older adult has severe long-term care needs and uses paid care, out-of-pocket costs average $140,000, according to research by my Urban Institute colleague Melissa Favreault. That enormous cost is generally spread over much less time, typically four years in contrast to 17.

But those estimates include only some of the total out-of-pocket expenses families face when a loved one has long-term care needs. They exclude costs of care during the time when a parent or spouse needs lower levels of paid assistance. They do not include costs incurred by their adult children. And, in contrast to the government's estimates of child rearing expenses, they exclude out-of-pocket spending for medical care.

However, health care expenses are a major strain on the budgets of older adults. The average total out-of-pocket cost for health care after age 65 is at least another $100,000. Those with chronic illnesses that lead to many long-term care needs pay far more than that.

What We Do For Kids

Yet, think about what the government does for families with kids. There is, of course, 12 years of free public school. And in many communities, there is access to charter schools or vouchers for private or religious schools.

For low- and middle-income households, there are tax credits such as the Earned Income Credit (EITC) and the Child Tax Credit (CTC). Families with one child can receive up to $3,400 annually from the EITC, and families with more kids can get up to nearly $6,300. They may receive another $1,000 per child from the CTC. Combined, these credits cost the government $26 billion annually.

There are additional credits for adoption, foster care, and child care.

When it comes to health care, there is Medicaid, which provides medical care for low-income families, including kids; and the $25 billion State Children’s Health Insurance Program (CHIP) that covers children from families whose incomes are a bit too high to qualify for Medicaid.  In addition, private insurance acquired through employers (including family insurance) is heavily subsidized through the tax code.  Last year, this subsidy was worth $145 billion.

What about long-term care for older adults and younger people with disabilities? Well, there is Medicaid, if you are poor enough and need a high enough level of care. Nearly all seniors are eligible for Medicare, of course. But despite a widespread misconception, Medicare covers only medical treatment, not personal supports and other long-term care.

Support for Aging Parents

You can deduct some long-term care costs from your federal income tax, but only if you’re total medical expenses exceed 10 percent of your income. And if you are poor (and if you are disabled you probably are), a tax deduction isn’t worth very much. For low- and middle-income families, it is much less generous than the tax credits available for families with kids.

There also are programs funded through the Older Americans Act, such as Meals on Wheels or information services, but spending for most of them has been frozen for years. Then there is…well, nothing.

If you require long-term care, you are pretty much on your own. Most families just take care of their loved ones on their own, without any paid assistance.  Of the $266,000 in average costs for those families who use paid care, $140,000, or 55 percent, is paid out of pocket.  Medicaid picks up about one-third on average, or about $90,000. But remember, only about 18 percent of Americans age 65 or older will ever qualify for Medicaid long-term care benefits.

I am in no way suggesting that the US reduce assistance for families--especially low-income families—who are raising kids. I am suggesting that we recognize that the financial burdens (to say nothing of the physical and emotional costs) are as high or higher for those who are caring for aging parents or younger relatives with disabilities.

A society has an obligation to be sure its kids are well cared-for. But it has the same responsibility for its frail elderly and disabled. The US is doing its share for its children. It is not doing so for its aging parents.

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Families Spend More To Care For Their Aging Parents Than To Raise Their Kids

States Look To Help Aging Parents Of Those With Disabilities

Emily Criss, who has developmental disabilities, with her mother Elizabeth.

ROCKVILLE, Md. — Ever since she was 4, when a caregiver force-fed her with a spoon, Caroline Munro has not let anyone feed her but her mother.

The 22-year-old has cerebral palsy and an intellectual disability. She doesn’t speak and functions at a preschool level. Her mother, Beth Munro, feeds her with a fork or her hand.

As Beth ages — she’ll be 68 in October — she wonders who will care for Caroline when she’s no longer around. But she may never know. Caroline is on a Maryland waiting list for additional Medicaid services for people with disabilities. The list is thousands of names long, and as in many states, names often stay on it until a caregiver falls ill or dies.

About 860,000 people over 60 nationwide are in Beth’s place, caring for someone with intellectual or developmental disabilities in their home. And many are waiting, sometimes for years, for state-provided Medicaid help for their child, sister or brother, such as placement in a group home, day services, or transportation or employment programs. If they can’t afford to pay for these services on their own, under the federal-state Medicaid system, their relative could end up in an institution.

As the number of older caregivers grows, and their need for help becomes more dire, a few states have passed laws to give older caregivers a chance to help decide where, and how, the person they care for will live. Tennessee passed a law in 2015 to ensure that anyone with an intellectual disability and a caregiver over 80 got the services they needed, and this year the state expanded the law to those with caretakers over 75. And in 2014, Connecticut passed a similar law that is helping about 120 people with a caregiver over 70.

But the waiting lists for needed services in these states and many others are still thousands of names long. In recent years, states such as Maryland, Virginia and Pennsylvania have put money into their budgets to try to chip away at the lists, and they get federal matching dollars to help pay for it. Some states are prioritizing people with urgent needs, while others are prioritizing students as they age out of school.

Yet advocates for people with disabilities, such as Nicole Jorwic, director of rights policy at The Arc, a national nonprofit, say there needs to be a federal fix.

“Something that pumps money into the system,” Jorwic said. “And that’s just not going to happen in the current climate in Congress.”

In Maryland, Beth Munro realizes that unless she becomes seriously ill or dies, her daughter might not be placed in a group home.

“I’ve worked really hard at the issue over the years,” Munro said, “and you get nowhere.”  (Click to Continue)

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States Look To Help Aging Parents Of Those With Disabilities

My Motherless Mother

By Candy Schulman

“I need to talk to you,” my 90-year-old mother announced in a stern tone usually reserved for reprimanding a child.

Visiting her in Florida, I noticed increasing balance problems and short-term memory lapses, early signs of Lewy body dementia. She perched on the bench of the organ my father had learned to play in retirement.

And she began to recite, like someone eager to have her past documented by an oral historian:

“I grew up in an orphanage. My mother didn’t want me.”

I froze — eager to listen, afraid of what she’d reveal.

“My father had tuberculosis and went to a sanitarium,” she continued. “After he died, my mother couldn’t afford to keep me at home. I went into the orphanage when I was 18 months old. I stayed until I was 15. Then I moved back home, where I lived until I married Daddy. I resented my mother.”

I was incredulous. At 53, I was hearing details of her past for the first time. She was a widow, recently surviving a heart attack. I was married with a teenage daughter. Mom had always been private, lapsing into Yiddish whenever she didn’t want me to understand. She’d dribbled out a few facts over the years: My grandmother left Russia after a broken love affair, fleeing to Ellis Island at the age of 17 — alone and penniless. My mother was raised in poverty in Jersey City. Occasionally I overheard the word “orphanage” in hushed tones. I didn’t dare to pry. She didn’t invite questions. Until now.

“When I was 7 they brought me into a room in the orphanage and said, ‘These are your older brothers.’ I didn’t even know I had brothers.”

Mother swallowed, took a breath. “My mother was supposed to visit once a month. But months would pass and she wouldn’t show up.” Her lips quivered. “I never had a mother. Never even had a doll.”

Suddenly I realized why she criticized me for buying my daughter too many toys. “Did your mother work?” I asked.

“She was so poor, she made and sold gin during Prohibition.”

No wonder Mother never drank. I started to tremble. As anxious as I felt diving deeper into her past, I knew this might be the only opportunity to discover why she’d been so distant, running away from friendships and intimacy. Her failing health compelled her to share memories of institutionalization with someone who’d remember.

“I’m stronger than you are,” she had often boasted when I was growing up, proud that she never even took a Tylenol. I was a sensitive child. She called my outbursts “crocodile tears.”

Now I watched real tears stream down the cheeks of the stoic stranger who’d never invited me to sit in her lap. Suddenly she hugged me. I could feel her shoulder blades in her diminutive frame. I fell into a back-and-forth rocking rhythm. I’d cradled my daughter — but never the woman who’d given birth to me.

Together we cried, for ourselves and for each other. Our embrace ended awkwardly, as if we’d been caught misbehaving.

“I once told my mother she didn’t love me,” Mother blurted. “She was shocked.”

Avoiding her gaze, I didn’t admit I’d wanted to accuse her of the same thing. As a child I’d often felt neglected, left alone at the age of 8, not understanding why Mom ran off to art classes rather than spend time with me. Chiseling sculptures eased her anxieties. My father called it “nervous energy,” but she was trying to keep the trauma she held inside from exploding. If I disagreed with her, she washed my mouth out with soap. Once she hit my face so hard for speaking back to her, my gums bled. When I wanted to major in journalism, she said, “You don’t have any talent.”

We spent our lives disappointing each other. I yearned for someone to praise and inspire me, but so did she. We both needed a good mother. She was always protecting herself from the scars of her early abandonment.

Now she confessed, “When I put my mother in a home, it was on the same grounds as my orphanage. Imagine how I felt each time I visited.”

I couldn’t. All I remembered was taking my grandmother out for ice cream on Sundays. How could my mother have kept such an anguished secret from me all those years? Not a word during the car ride from Brooklyn to Jersey City and back. As if we were any mother and daughter visiting an octogenarian in any nursing home. My mother had kept her secret from me all these years — until she suspected that soon it might be too late.

“Don’t ever put me in a home,” she said, sounding desperate.

(Continue Reading)

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My Motherless Mother

Who’s responsible in caring for aging parents?

Powder Springs Police Chief Charlie Sewell

In a recent conversation, a woman grumbled that her elderly father squandered his money, didn’t make good career decisions and now he expected her to provide for his financial support. Some people say adult children are obligated to support their elderly parents just as the parent supported them when they were little. People who have personal financial issues, those that were reared in a dysfunctional family or those who have a host of other reasons, may not agree with that philosophy.

Licensed care facilities have a legal obligation to care for the wellbeing of their clients, but what legal obligation does an adult child have toward an indigent elderly parent? The answer to that question is hotly debated, surrounded by deep-rooted emotions, and there are probably as many opinions as there are elderly parents.

Society today makes it real clear that it is a crime when a parent neglects to give adequate nourishment to a child. But what if an adult child neglects to give adequate nourishment to an indigent elderly parent? What if an adult child neglects to provide other support for an indigent elderly parent? Is it morally reprehensible? Is it abuse? Is it a crime? Or is it just the elderly reaping what they sowed?

Some folks, who I will call the liberated, believe that adult children have no more moral obligation to support their elderly parents than any other person, and it doesn’t matter how much expense, trouble, love or care the parent gave them as a child. They also believe that it doesn’t matter how destitute or sick their parents become, it is simply not their responsibility. The philosophy of the liberated surrounds the fact that they did not ask to be born. They believe the elderly person should be self-supportive or be a ward of society.

There are also people who I will call the duty-bound who begrudgingly care for their elderly parents out of some type obligation, and the devoted who assume that responsibility without giving it a second thought.

The level of responsibility, however, doesn’t necessarily rest in the opinion of the adult child. Georgia is one of 30 states that has a filial responsibility law that casts some duty upon adult children to support their indigent parents.

Years ago, when Medicaid began financially helping the indigent elderly, some states reversed their filial support laws; others just allowed their laws to go unenforced. As the cost of elder care continues to rise, so does the debate on who should be responsible for that care. The norm of today might be different tomorrow.

Georgia statute states in part that “the father, mother, or child of any pauper, if sufficiently able, shall support the pauper.” If another entity pays for the support of an elderly pauper, said entity might seek legal action against the adult child in order to recover their loss.

I do not profess to be an interpreter of civil law, nor am I a lawyer; but whether you are liberated, duty-bound, devoted or think of yourself as an innocent bystander, it is better to know where you stand than to assume. Seeking legal advice now might help you to be prepared emotionally, legally and financially, and it might prevent surprise and heartache in the future.

Charlie Sewell is the retired Powder Springs police chief and is on the board of directors for the Cobb Elder Abuse Task Force. His columns run monthly in the MDJ.

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Who’s responsible in caring for aging parents?