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Senior Planning

Senior Planning

Take care to prepare

What was once a demographic ripple has become a full-blown wave — and it’s getting bigger.

According to the U.S. Census Bureau, in 2000, the number of adults age 65 and older was 35 million, or 12.4% of the total population. In 2016, the number of seniors had risen to 49.2 million or 15.2% of the population.

By 2030, the bureau estimates, more than 20% of U.S. residents will have passed their 65th birthdays, and by 2035, that demographic will outnumber children younger than 18 — an unprecedented swing.


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What does all this mean?

It means it’s time to prepare — the sooner, the better.

As the Baby Boom generation continues to march into their retirement years — at the rate of 10,000 per day — Americans are living longer than ever. But what that life will entail, post-65, can wildly vary depending on lifestyle preferences, health status, finances, and more.

The questions are myriad. What levels of care are available, and what do they include? How will I pay for all of this, especially if I, or my parents, live well past 80 or 90? How do I approach mom or dad with my concerns that they might not be able to live alone anymore? What’s an estate plan, and what documents do I need to worry about?

It’s a lot to think about, and no single guide can answer all those questions. But hopefully, this special section will sort through some of the confusion and get those conversations started.

Senior Planning

Don’t Neglect Any of These Five Important Steps

Whether you’re taking care of a family member full-time or just beginning to anticipate a need, the American Association of Retired Persons recommends a series of five steps to make the process easier for both you and your loved one. Just take it one step at a time.

1. Start the Conversation

Ask your loved one about their wishes, values, and preferences on things that matter, from health to finances. If you wait until a fall, accident, or serious diagnosis, your choices may be more limited, more difficult to evaluate, and made hastily under stress.

Look for an opening. Rather than bringing up a tough topic out of the blue, it can help to point to a newspaper story or a relevant comment as a conversation starter. (Example: “You mentioned your eyes are bothering you. Is this causing problems with reading or driving?”)

It can be hard for some people to admit they need help. If your first conversation doesn’t go well, gently try again. Listen to and respect your loved one’s desires. If you are repeatedly shut out, consider asking another trusted family member, friend, or doctor to approach them about your concerns.

2. Form a Team

Don’t go it alone. Trying to handle the responsibilities of caregiving yourself can lead to burnout and stress-related health problems. It’s important to form a larger network of friends, family, and community resources to help you. Remember to consider your loved one part of the team.

Then, decide who’s in charge. It’s important to have a point person to keep the process moving and make sure everyone on the team understands the plan and priorities. In most families, one person assumes the primary role because he or she lives nearby, has a close relationship, or simply is a take-charge person. That may be you.

Also, consider a mediator. It can be useful to engage an unrelated facilitator, such as a social worker or minister, to help keep everyone focused, manage potential disagreements, and communicate difficult subjects when meeting with your team.

3. Make a Plan

Now it’s time to work with your team to develop a plan. You can’t anticipate every detail or scenario, but being forward-thinking now will help you respond more quickly and effectively in an emergency. It also helps assure that everyone keeps the focus on what’s best for your loved one.

You’ll need to determine roles. Ask your caregiving team members about what tasks they can and are willing to take on. Who is free to travel to medical appointments? Who can prepare meals a few times a week? Who can be responsible for bill paying?

Finally, summarize the plan in writing. A written record will assure everyone is on the same page and help avoid misunderstandings (while remembering, of course, that the plan will likely change as time passes).

4. Care for Your Loved One

This step encompasses the others, of course, and every caregiver’s situation is different. But there are a wide range resources and tools that can make your job easier, whether you’re caring for a parent from another state, a spouse with a long-term illness, or a family member with dementia.

Advocate for yourself. Let the doctor know if you are the primary caregiver and need to be informed about your loved one’s condition and the treatments prescribed. Ask for training on procedures you’ve never done at home, such as injecting medication or changing bandages.

If the person you’re caring for has more difficulty getting around or their vision or hearing fades, implement some simple changes to make their home less hazardous. Consider installing things like handrails, grab bars, nightlights, and adjustable shower seats.

5. Care for Yourself

It’s easy to forget about your own needs, which is why caregivers are more likely to report high stress levels and suffer from depression and other health problems. Don’t neglect exercise, sleep, and healthy eating, and take time for activities you enjoy. You’ll need to keep up your energy and stay well to care for others.

Understand that your personal finances can take a hit from family caregiving — which might require time off of work, cutting back on hours, or passing up promotions, as well as paying for things like groceries and prescriptions for your loved one from your own pocket. Also, find out if your workplace will accommodate your working from home part-time or making certain adjustments to your schedule.

Finally, give yourself a break. Sometimes caregivers feel guilty about taking time to have fun. Find ways to reduce your stress and enjoy yourself.

Senior Planning

A Challenging First Step

By Joe Gilmore, Landmark Senior Living

Talking about long-term care needs with an elderly parent or other loved one can be a difficult thing. You may not know exactly how to approach it without coming off as rude or disingenuous. However, when it comes to a loved one’s health, it is important to cast aside how you feel to ensure that they can live safely and happily later in life. It is especially important to have this conversation before a problem occurs, not after.

An American Assoc. of Retired Persons survey found that two-thirds of adult children have never had this conversation. This is most likely due to the fact that a lot of adult children don’t know how to engage in this type of talk, or how to begin it. To begin, you have to decide who is going to be there during the talk and what the discussion is going to center around.

Keeping your loved one or parent safe later in their life is a priority, and talking to them about living situations, such as assisted living or even enlisting the help of a caregiver, is the first step. This is especially true if your parent or loved one has experienced a traumatic event in the recent past, such as a fall or the loss of a spouse.

Tips for the Talk

• Decide how you are going to do it and who’s going to be there. Sometimes a one-on-one talk is best; however, if you need someone to back up your points or provide another point of view, it may be a good idea to get other family members involved.

• Go over which talking points you will speak on before approaching your loved one, and set up a time and place to talk.

• Express each idea as an opinion of yours rather than a need for them. For example, choosing phrases like “I think” or “I need” rather than “you should” or “you need” are good ways to avoid conflict.

• Remind your loved one that everyone is there because they care and want to help keep them safe.

• Stay calm. Don’t raise your voice, speak over your loved one, or encourage any hostility during this discussion, as it will only make the situation worse.

• If your loved one immediately dismisses the idea of leaving their home, it may be best to drop the issue for the moment and bring it back up at another time.

The first step in beginning the talk is setting up how you are going to do it and who’s going to be there. Sometimes it is best for the talk to be a one-on-one; however, if you need someone to back up your points or provide another point of view, it may be a good idea to get other family members or loved ones involved. Every family is different, and it may be a good idea to disregard some family members when deciding who is invited to speak.

It is best to go over which talking points that you will speak on before approaching your parent or loved one. Meeting beforehand to talk about these things is recommended. Create a plan on how you wish to talk about this.

Understanding Your Loves Ones’ Goals for the Future

Your conversation about the future doesn’t have to focus only on a caregiving plan. You may also consider talking generally with your loved ones about what is important to them as they grow older. This checklist can be used as a starting point to better understand their priorities. Start by asking then to check all those that apply and then spend some time talking about each one in a little more detail:
__ To remain as independent as possible for as long as possible

__ To remain healthy and active

__ To remain in my home as long as possible

__ To focus on a hobby

__ To work for as long as possible

__ To become involved in the community

__ To remain as financially independent as possible

__ To take classes

__ To create a safety net in the event of an emergency or crisis situation

__ To start my own business

__ To buy a second home

__ To move closer to my family

__ To relocate to a smaller home

__ To retire in a different place

__ To travel

__ To be able to help my children and grandchildren

After going over the points you will make, the first thing you’ll want to do is set up a time and place to talk with your parent or loved one. This may require the use of some type of web communications like Skype or just over the phone if someone can’t be there or lives in a different area.

Depending on how you are hoping to help your parent, there are a few ways to go about this. For example, if you are just hoping to enlist the help of a caregiver, or become the caregiver yourself, it will take less convincing than, say, getting them to agree to be admitted to an assisted-living or residential care facility.

When speaking with a parent or a loved one about what you feel they should do, it is best to phrase it in a way that expresses that it is an opinion of yours rather than a need for them. For example, choosing phrases like “I think” or “I need” rather than “you should” or “you need” are good ways to avoid conflict.

Be sure to remind your parent or loved one that everyone is there because they care and want to help keep them safe. It may even be beneficial to bring up times when your parent may have had their health put at risk — maybe a fall or another incident.

This is also true for other major events like the loss of a spouse. There is evidence that the social isolation that stems from living alone and independently can lead to problems like loneliness and depression.

It is also important not to raise your voice or encourage any hostility during this discussion, as it will only make the situation worse. You should also be aware of when your parent is trying to talk. Do not try to speak over them, as it will likely lead to an argument. Keep your cool and remain calm during the discussion, even if others don’t.

Some parents will dismiss the idea of moving to an assisted-living facility immediately or adamantly. If this is the case, it may be best to drop the issue for the moment and bring it back up at another time down the road.

At the end of the meeting, make sure everyone has a clear understanding of the issues, concerns, and considerations presented.

Senior Planning

Choosing the Right Level of Care Begins with Understanding All of Them

By the Massachusetts Senior Care Assoc.

Massachusetts has a broad array of care options and a national reputation for quality. Understanding the different types of healthcare services offered by providers is the first step to determining which care option best fits your needs.

Skilled Nursing and Rehabilitation

Nursing facilities provide both short- and long-term care services for older adults and people with disabilities or chronic illnesses.

Of the more than 120,000 people Massachusetts Senior Care Assoc. members care for annually, close to two-thirds return to their community within one month after a brief, post-hospital, rehabilitative stay. With ever-shortening hospital stays, skilled-nursing facilities have become the preferred choice for discharged hospital patients who need short-term transitional care before they can return safely to their homes. Those who cannot live safely and comfortably at home receive precisely the care and community they need as long term residents of Massachusetts’ nursing and rehabilitative facilities.

Short-term care is available for individuals who have been hospitalized and need a period of medical monitoring and/or rehabilitation before returning home. Often referred to as subacute or transitional care, this kind of care can be provided in a free-standing nursing facility or a hospital-based skilled-nursing unit. Most stays are for fewer than 30 days, after which the patient usually returns home. This kind of care can be beneficial after a surgery or a prolonged hospitalization, or for rehabilitation following a stroke or other serious medical event.

Long-term care is available for people who are unable to live safely and comfortably at home, require 24-hour nursing care and support, and need help with many of the activities of daily living, such as eating, dressing, toileting and bathing. When considering long-term nursing facility care, it is important to discuss the issue thoroughly with the person involved and his or her personal physician before the situation becomes an emergency. Finding the right facility can take time, and since some facilities have waiting lists, it helps to plan ahead so space will be available when it is needed.

Among the services provided are 24-hour nursing care; rehabilitative care such as physical, occupational, speech, and respiratory therapy; and help with personal care such as eating, dressing, toileting, and bathing. In addition, a growing number of nursing facilities provide post-operative rehabilitative care, inpatient and outpatient rehabilitation, Alzheimer’s/dementia specialty care, respite care, restorative and residential care for people with multiple sclerosis and other neurological disorders, pediatric specialty care, and acquired brain-injury specialty care.

Assisted Living

Assisted-living residences are for older people who no longer feel comfortable or safe living alone, but do not need 24-hour nursing and medical care. While assisted-living residences monitor the well-being of their residents and help coordinate health services by licensed outside agencies or providers, they do not provide these services directly and are not designed for people with serious medical needs. State law prohibits assisted-living residences from admitting or retaining individuals who need skilled nursing care for more than 90 days in a 12-month period.

Assisted living residences combine apartment-like living with a variety of support services, including meals, assistance with activities of daily living such as bathing and dressing, on-site staff to respond to emergencies and help with medications, housekeeping and laundry services, social and recreational programs, and 24-hour security.

Assisted-living residences have one- or two-bedroom units with private bathrooms and entry doors that lock. Some units may also have a living or sitting room. In addition to a group dining area, assisted-living residences typically provide either a private kitchenette or access to a communal cooking area. Units are usually furnished with a resident’s personal belongings and furniture.

Continuing-care Retirement Community

Continuing-care retirement communities (CCRCs) combine independent retirement housing, assisted-living services, and nursing facility care, usually on the same campus, to allow elders to have their current and future care needs met at one location. As a senior’s needs change, he or she can choose from among the services and care settings available.

CCRCs are another option for older people who no longer want the responsibility of caring for a house and want the peace of mind of knowing that they have planned for their future long-term-care needs. Most CCRCs require incoming residents to be fully capable of independent living upon entering, or may impose conditions based on certain pre-existing conditions. However, some CCRCs allow residents to enter their assisted-living units directly from the community.

CCRCs also provide assisted-living services (either in separate assisted-living units or to individuals residing in the independent living units) and 24-hour nursing-facility care.

Most independent-living units in a CCRC consist of one or two bedrooms, a living room, a kitchen, and a full bathroom. CCRCs typically have a number of common areas, including one or more resident dining rooms, and many also have libraries, hair salons, convenience stores, exercise and game rooms, and banking facilities.

Other Care Options

• Adult day health programs, also known as adult day care centers, provide supervision, recreation, health, and personal-care services during the day to older people so that family caregivers can work or attend to other responsibilities. All adult day health programs must meet minimum standards set by the Massachusetts Medicaid program, also known as MassHealth. Adult day health programs are provided either on a private pay basis or through Medicaid.

• Adult foster-care programs match elders who are no longer able to live alone with families willing to provide room and board and personal care. Families are paid a stipend by MassHealth for elders who are Medicaid-eligible. Some adult foster-care funding is also available to pay for assisted-living services for people who are clinically and financially eligible through the state’s Group Adult Foster Care Program.

• Congregate housing facilities provide a living arrangement in which elders have a private bedroom and share common space with others. Support services are usually available to help elders maintain their independence. Most congregate housing sites are sponsored by local municipal housing authorities or nonprofit organizations. Public congregate housing is partially subsidized by the state or federal government.

• Home-based services help individuals live independently at home and are provided by home health agencies, visiting nurse associations, and state-funded home-care corporations (called aging services access points, or ASAPs). They include homemaker services to maintain household functioning, including help with home management, shopping, meal preparation, and light housekeeping; and personal care, including bathing, dressing, grooming, and toileting. They may also provide health services; home health aides provide basic healthcare services such as personal care, recording temperatures and checking pulses, changing simple bandages, and assisting with self-administered medications, while licensed nurses and therapists provide skilled nursing care and therapeutic services.

• Hospice care serves patients with a life-threatening illness and a life expectancy of six months or less. Hospice care may be provided in the home, nursing facility, or hospital, and the hospice team works cooperatively with the patient, family, physician, and other caregivers to provide specialized care that is focused on comfort, not cure. The hospice team includes the patient’s physician, hospice medical director, registered nurses, home health aides, licensed social worker, bereavement counselor, pastoral counselor, rehabilitation therapists, and volunteers.

• Resident Care Facilities (RCFs), also known as rest homes, provide housing, meals, 24-hour supervision, administration of medications, and personal care to individuals who do not routinely require nursing or medical care.

• Respite care is short-term care provided at home, in a nursing facility, or in an assisted-living residence to give families caring for elders at home some time off from their caregiving responsibilities.

• Finally, independent-living senior communities are an option if you want to live on your own, but don’t want to have all the chores that go along with having a home. It’s also a great option for people who want to live in a community with other seniors. Depending on the community you choose, you can rent an apartment either at the market rate or, if your income level applies, a lower rate. They are often specially designed with things like railings in bathrooms or power outlets higher up on the wall. They may also offer a 24-hour emergency call service if residents need help right away. Some facilities may also offer services like meals, transportation, social activities, and other programs.

Senior Planning

What Options Are Available?

Many seniors are not aware of the options available for affordable housing and care as they age. In Massachusetts, there are a few financial-assistance programs that can assist low- to moderate-income seniors pay for both housing and care options. Residential care homes in Massachusetts offer seniors and disabled adults affordable housing options that include services such as homemade meals, snacks, scheduled activities, housekeeping, laundry, and clinical oversight with medication management.

“Many homes, like the Lathrop Home, offer private rooms, with shared common areas and daily activities to enrich the lives of the residents we serve,” said Crystal Cote-Stosz, executive director of the Northampton facility. “For many individuals, the offerings of a residential care home can bridge the care gap by providing assistance that is customized and affordable. Finances are a major consideration with life’s transitions, and for those of us needing support services such as meals, medication management, and assistance with personal care, making these choices can be difficult. Luckily for Massachusetts residents, subsidized care options are available in many residential care homes and assisted-living facilities.”

Paying for care is a significant stressor for families, especially for those who have not planned ahead or saved enough. According to a TD Bank study, one in five Millennials helps to financially support their aging parents, to the tune of $18,250 per year on average, and nearly three-quarters of the financial aid goes towards general living expenses like food and housing.

Both the state and federal government offer subsidy programs for residential care facilities, like the Lathrop Home, Cote-Stosz noted. The federal subsidy that assists individuals pay for residential care is through the Supplemental Security Income (SSI) program combined with the state Supplemental Security Program. Both programs work together to supplement an individual’s income to pay for the care provided by a residential care home.

The state program that assists residents in Massachusetts pay for residential care is called EAEDC (Emergency Aid to Elderly and Disabled Children). Residential care facilities like the Lathrop Home can have residents with monthly incomes up to $3,450 qualify for assistance paying for care. Many Massachusetts residential care facilities offer nursing on staff to triage residents’ clinical care needs, which allows individuals to remain independent from long-term care.

Residential care facilities provide application assistance for the financial-assistance programs available to those residents that spend down or require a subsidy application from point of admission. Individuals interested in residential care should visit the Massachusetts Assoc. of Residential Care Homes website at maresidentialcarehomes.org.

Senior Planning

These regional and statewide nonprofits can help families make decisions and access resources related to elder-care planning.

AARP MASSACHUSETTS

1 Beacon St., #2301, Boston, MA 02108

(866) 448-3621; states.aarp.org/region/massachusetts

Administrator: Mike Festa

Services: A nonprofit, nonpartisan, social-welfare organization with a membership of nearly 38 million that advocates for the issues that matter to families, such as healthcare, employment and income security, and protection from financial abuse.

THE CONVERSATION PROJECT

20 University Road, 7th Floor, Cambridge, MA 02138

(617) 301-4868; www.theconversationproject.org

Administrator: Kate DeBartolo

Services: Helps people talk about their wishes for end-of-life care; its team includes five seasoned law, journalism, and media professionals working pro bono alongside professional staff from the Institute for Healthcare Improvement.

ELDER SERVICES OF BERKSHIRE COUNTY INC.

877 South St., Suite 4E, Pittsfield, MA 01201

(413) 499-0524; www.esbci.org

Administrator: Christopher McLaughlin

Services: Information and referral, care management, respite care, homemaker and home health assistance, healthy-aging programs, and MassHealth nursing home pre-screening; also offers housing options, adult family care, group adult foster care, long-term-care ombudsman, and money management, and oversees Senior Community Service Aide Employment Program.

GREATER SPRINGFIELD SENIOR SERVICES INC.

66 Industry Ave., Suite 9, Springfield, MA 01104

(413) 781-8800; www.gsssi.org

Administrator: Jill Keough

Services: Dedicated to maintaining quality of life for older adults, caregivers, and people with disabilities, through programs and services that foster independence, dignity, safety, and peace of mind; services include case management, home care, home-delivered meals, senior community dining, money management, congregate housing, and adult day care.

HIGHLAND VALLEY ELDER SERVICES

320 Riverside Dr., Florence, MA 01062

(413) 586-2000; www.highlandvalley.org

Administrator: Allan Ouimet

Services: Care management, information/referral services, family caregiver program, personal emergency-response service, protective services, home-health services, chore services, nursing-home ombudsman services, adult day programs, elder-care advice, bill-payer services, options counseling, respite services, representative payee services, local dining centers, personal-care and homemaker services, and home-delivered meals.

LIFEPATH

101 Munson St., Suite 201, Greenfield, MA 01301

(413) 773-5555; www.lifepathma.org

Administrator: Barbara Bodzin

Services: Private, nonprofit corporation that develops, provides, and coordinates a range of services to support the independent living of elders and people with disabilities; also supports caregivers, including grandparents raising grandchildren.

MASSACHUSETTS ASSOC. OF OLDER AMERICANS

19 Temple Place, Boston, MA 02111

(617) 426-0804; www.maoamass.org

Administrator: Chet Jakubiak

Services: Aims to improve the economic security of older Massachusetts residents through research and advocacy on policies that may reduce risk and hardship; fights against the dual stigma of being old and mentally ill, to preserve Medicare and Social Security, to ensure access to community-based long-term care, and to obtain mental healthcare for elders suffering from depression and other brain disorders.

MASSACHUSETTS EXECUTIVE OFFICE OF ELDER AFFAIRS

1 Ashburton Place, Unit 517, Boston, MA 02108

(617) 727-7750; www.mass.gov/elders

Administrator: Elizabeth Chen

Services: Connects seniors and families with services like senior centers, councils on aging, nutrition programs such as Meals on Wheels, exercise, health coaching, and more; supports frail adults through programs and quality-improvement initiatives in nursing homes and assisted-living facilities; caregiver support programs.

MASSACHUSETTS SENIOR LEGAL HELPLINE

99 Chauncy St., Unit 400, Boston, MA 02111

(800) 342-5297 ; www.vlpnet.org

Administrator: Joanne Allison

Services: The Helpline is a project of the Volunteer Lawyers Project of Boston that provides free legal information and referral services to Massachusetts residents age 60 and older; the Helpline is open Monday through Friday, 9 a.m. to noon.

MASSOPTIONS

(844) 422-6277

www.massoptions.org

Administrator: Marylou Sudders

Services: Connects elders, individuals with disabilities, and their caregivers with agencies and organizations that can best meet their needs; staff can also assist with determining eligibility for and applying to MassHealth.

VA CENTRAL AND WESTERN MASSACHUSETTS HEALTHCARE SYSTEM

421 North Main St., Leeds, MA 01053

(413) 584-4040; www.centralwesternmass.va.gov

Administrator: John Collins

Services: Provides primary, specialty, and mental-health care, including psychiatric, substance-abuse, and PTSD services, to a veteran population in Central and Western Mass. of more than 120,000 men and women.

WESTMASS ELDERCARE INC.

4 Valley Mill Road, Holyoke, MA 01040

(413) 538-9020; www.wmeldercare.org

Administrator: Roseann Martoccia

Services: Provides an array of in-home and community services to support independent living; interdisciplinary team approach to person-centered care; information, referrals, and options counseling as well as volunteer opportunities available.

Senior Planning

When It’s Time to Leave Home: Making the Change

By the National Institute on Aging

The decision about whether your parents should move is often tricky and emotional. Each family will have its own reasons for wanting (or not wanting) to take such a step. One family may decide a move is right because the parents can no longer manage the home. For another family, the need for hands-on care in a long-term care facility motivates a change.

In the case of long-distance caregivers, the notion of moving can seem like a solution to the problem of not being close enough to help. For some caregivers, moving a sick or aging parent to their own home or community can be a viable alternative. Some families decide to have an adult child move back to the parent’s home to become the primary caregiver.

Keep in mind that leaving a home, community, and familiar medical care can be very disruptive and difficult for the older parent, especially if they are not enthusiastic about the change. You might first want to explore what services are available in your parents’ community to help them in their home — including home health care, housekeeping, personal care, and transportation services.

Myriad options exist when it comes to deciding where to live, but these choices can be limited by factors such as illness, ability to perform activities of daily living (for example, eating, bathing, using the toilet, dressing, walking, and moving from bed to chair), financial resources, and personal preferences.

Tips for the Transition

• Keep in mind that leaving a home, community, and familiar medical care can be very disruptive and difficult for the older parent. First explore what services are available in their community to help them in their home.

• Some families find a conference call is a good way to talk together about the pros and cons of each option. The goal of this call is to come up with a plan that works for everyone, especially your parent.

• Many older adults want to ‘age in place’ — to stay in their own homes as they get older — but may have concerns about safety, getting around, or other daily activities. A few changes could help the resident continue to live independently.

• Whatever your decision, try not to let your parent or loved one feel threatened or forced.

Older adults, or those with serious illness, can choose to stay in their own home or move to a smaller one, move to an assisted-living facility, move to a long-term care facility, or move in with a family member. Making a decision that is best for your parent — and making that decision with your parent — can be difficult. Try to learn as much as you can about possible housing options.

Some families find a conference call is a good way to talk together about the pros and cons of each option. The goal of this call is to come up with a plan that works for everyone, especially your parent. If the decision involves a move for your mom or dad, you could, even from a distance, offer to arrange tours of some places for their consideration.

Experts advise families to think carefully before moving an aging adult into an adult child’s home. There are a lot of questions to consider. For example, is there space in your home? Is someone around to help the older person during the whole day? What are your parents able to do for themselves? What personal care are you willing and able to provide — moving your parent from a chair to a bed or toilet, changing adult diapers, or using a feeding tube, for example? What kinds of home-care services are available in your community? What kind of specialized medical care is available nearby?

Many older adults want to ‘age in place’ — to stay in their own homes as they get older — but may have concerns about safety, getting around, or other daily activities. A few changes could make the home easier and safer to live in and help the resident continue to live independently.

For example, don’t use area rugs, and check that all carpets are fixed firmly to the floor. Replace handles on doors or faucets with ones that are comfortable for you to use. Install grab bars near toilets and in the tub or shower. Reduce fall hazards by placing no-slip strips or non-skid mats on tile and wood floors or surfaces that may get wet. Place light switches at the top and bottom of stairs and remember to turn on nightlights. Install a ramp with handrails to the front door.

Whatever your decision, try not to let your parent or loved one feel threatened or forced. Help them understand you have their best interest at heart, and want to find a solution that works for everyone.

Senior Planning

The Four Key Documents of an Estate Plan

By Gina Barry

Consider this — tomorrow, you take a terrible fall.

You are injured to the point that you cannot communicate, or worse yet, you pass away. No one expected this to happen. Your loved ones are reeling. They are in shock and not thinking clearly.

Gina Barry

By Gina M. Barry, Esq.

They are now immediately called upon to act on your behalf. Do you know who will handle your affairs? Have you given that person the legal authority they would need to do so without added cost, time, and administrative difficulties? If your estate plan is in place and up to date, your affairs can be handled efficiently and effectively, leaving your loved ones to grieve the tragedy without all the added stress of navigating your affairs blindly and without authority.

Thus, every adult should have an estate plan in place. Fortunately, a basic estate plan is quite simple to establish. It requires four documents:

Last Will and Testament

The will is the document most people think of when contemplating an estate plan. Your will directs how your probate assets will be distributed after you pass away.

When you die, your probate assets are those assets held in your name alone that do not have a designated beneficiary. If you pass away without a will, your estate will be distributed in accordance with the Commonwealth’s intestacy laws, which may not be as you would have wanted.

A common misconception is that a will is not needed unless you have a lot of assets; however, a will can do much more than simply distribute assets. A will is necessary for you to name a personal representative (formerly known as executor), who will carry out your estate. Your personal representative will gather your probate assets, pay valid debts, and distribute the balance as set forth in your will.

Further, if you leave behind minor or disabled children, a guardian can be named in your will to take custody of these children. Likewise, a trust can be established in a will to provide ongoing protection for minor or disabled children as well as for other beneficiaries who should not receive their inheritance outright, usually due to spendthrift concerns. When there is no will in place, your power to make these designations and to direct the distribution of your property is forfeited.

Many also believe that, if every asset is jointly owned or has a designated beneficiary, a will is not necessary. For such a plan to be successful, the joint owner or beneficiary must survive you. If they do not survive you, your estate will need to be probated, which is when your will would direct the distribution of those assets.

Further, there are some instances where joint ownership cannot carry out your wishes, such as when you have more than one child, but cannot add all of their names on the same account due to the financial institution’s practices or because one or more of your children cannot be trusted to have access to your account as a joint owner during your lifetime.

Healthcare Proxy

A healthcare proxy is a document that designates a healthcare agent, who would make healthcare decisions for you if you were unable to make them for yourself.

Your healthcare agent would step into your shoes and make your decisions as you would if you were able. For example, your agent may decide whether a certain medication should be taken, a certain medical procedure should be done, or an admission or discharge from a medical facility should occur. Should you lose capacity and not have a healthcare proxy in place, your loved ones would need to petition the Probate Court to become your guardian, which is a lengthy, expensive, and public process that most would rather avoid.

‘Living-will’ language is normally included within the healthcare proxy, as it addresses your end-of-life decisions and generally sets forth that you do not want extraordinary medical procedures used to keep you alive when there is no likelihood of recovery. This can be a difficult decision to carry out; therefore, care should be taken to name someone who would be able to honor that decision.

If you have a terminal illness or are of advanced age, you also should consider establishing Medical Orders for Life-Sustaining Treatment (MOLST) in addition to your healthcare proxy. A MOLST is a form completed by you and your physician that relays instructions about your care. A MOLST would eliminate the need for living-will language in a proxy, but the best practice would be to reference the MOLST in your proxy.

Durable Power of Attorney

A durable power of attorney is a document that designates someone to make financial decisions for you. This document is usually in full force and effect when it is signed, but it is expected it will not be used unless you want help with or are unable to handle your own financial affairs.

It is also possible to grant a springing power that does not take effect until incapacity arises. Should you lose capacity and not have a durable power of attorney in place, your loved ones will have to petition the Probate Court to become your conservator, which, just like the guardianship process, is also lengthy, expensive, and public.

The durable power of attorney is a very powerful document with authority that is as broad as the powers granted within it. It gives power to the person you name to handle all your financial decisions, not just pay your bills. In most cases, the person named will be authorized to handle your real estate, life insurance, retirement accounts, other investment accounts, bank accounts, and any other matters involving money, such as tax returns and applications for public benefits.

As such, the person chosen to serve in this capacity should be someone with financial savvy who can be absolutely trusted to use your assets for only your benefit.

Homestead Declaration

For Massachusetts homeowners, a homestead declaration, once properly recorded in the Registry of Deeds, will declare your principal residence to be your homestead. The homestead declaration protects the equity in your primary residence up to $500,000 from attachment, seizure, execution on judgment, levy, or sale for the payment of debts.

In some cases, such as advanced age or disability, the equity protection can be up to $1 million. If a homestead declaration is not recorded, there is an automatic $125,000 of equity protection. It should be noted that, in addition to some other specific exceptions, a homestead declaration will not protect your real estate from nursing-home costs or tax liens.

Conclusion

While incapacity and death are not the most joyous of topics, when faced with them, most people would prefer to have a plan in place to ensure their needs and goals will be met.

You can help your loved ones avoid expensive legal hassles related to your ongoing care and your estate. Individuals with more complicated estates may require different or additional documents to fully protect their interests, but for most, an estate plan is only four documents away.

Gina Barry is a partner with the law firm Bacon Wilson, P.C. She is a member of the National Assoc. of Elder Law Attorneys, the Estate Planning Council, and the Western Massachusetts Elder Care Professionals Assoc. She concentrates her practice in the areas of estate and asset-protection planning, probate administration and litigation, guardianships, conservatorships, and residential real estate; (413) 781-0560; [email protected].