There Are Many Issues to Consider When Children Care for Parents
The Ultimate Role Reversal
By HYMAN G. DARLING, Esq.
One of the most challenging aspects of aging can be the role reversal that often occurs as aging parents need care from their adult children.
This dynamic can be very unsettling for all involved; it is difficult for some parents to admit they need help, and then to accept that help, and it is difficult for some children to provide the care and support an elderly parent may require. Where possible, it is always best to address these situations as a family group, and as far in advance as possible.
If you see a situation arising in which your parent will need care, you should begin planning to assess their needs and wants. If a parent has multiple children, this planning should include them all. Sadly, siblings often perceive each other as taking advantage of parents for financial gain. Even more sadly, some children do indeed take financial advantage of elders. A family group working together can benefit both parents and children, with the hope that the joys and hardships of caring for parents will be shared between siblings.
It is often a good idea to enlist the services of a geriatric care manager. These professionals generally possess a wealth of information about available services and programs, and can provide support to elders and children alike. A care manager can also assist with admission to an assisted-living or nursing facility, if and when that becomes necessary. They will have ideas and strategies to share about every aspect of elder care, from financial considerations to mental health resources; from medication management to respite for caregivers.
The plan must focus on parents’ needs. These will almost always include transportation, medical care, dietary needs, hygiene, assistance with finances or record keeping, and household duties. The plan should also include possible avenues to recognize and adapt to parents’ changing needs, because medical issues may increase, and additional services may become required. Some ideas or services that families find helpful include adult day-care facilities, permanent or temporary institutionalization, or perhaps even moving parents between siblings.
The needs of parents, however, are not the only consideration. Children caring for aging parents may become depressed or overwhelmed, so any well-thought-out care plan must also include support for caregivers.
These caregivers often need counseling, particularly those caring for a parent with dementia, which comes with its own unique set of demands and challenges. There are many counselors and support groups that can help caregivers realize they are not alone, help to deal with ongoing or changing issues at home, and preserve their own mental and physical health. Additionally, paid home care may be a good supplement to care from family members, when the primary caregivers need respite.
Financial planning is also a crucially important part of the considerations. Often, caregiver children may need to use the Family Medical Leave Act to take a leave of absence from employment. Some may even stop working in order to stay home and provide care for the aging parent. The family may wish to meet with an attorney and draw up a written agreement where parents will financially compensate children for care. These ‘parental-care agreements’ can be an important tool to use when an elder is staying at home.
Finally, be ready to recognize that in-home care from children may not be possible or appropriate for every family. In some cases, it is simply not possible to avoid a nursing home. This may be due to financial considerations, extensive care needs that a child cannot provide, or some combination thereof. Institutionalization in a nursing home is generally quite expensive, and can cost upwards of $10,000 per month in some cases.
It is heartbreaking to realize that a lifetime of savings may be wiped out by long-term-care expenses. There are, however, strategies that families may use to cope with the expense.
Faced with a health crisis and the possibility of nursing-home care, many families are tempted to transfer money from parents to children as soon as illness strikes. Such a transfer is not an effective way of securing family assets. In many cases, any transfer of funds from the elder will commence a five-year waiting period for federal and/or state long-term-care benefits. With very rare exceptions, this five-year waiting period applies to all elders who have made a transfer, regardless of the value of the gift or the intention behind it.
Long-term-care insurance is becoming more and more appealing as a means to protect assets in the event of institutionalization. Generally, this insurance may be used to cover or defer the cost of a nursing-home, or even to pay for in-home care. Some insurance companies may even combine life insurance, annuity, and long-term-care benefits within a single policy.
Those considering purchasing a long-term-care insurance policy should consider all the risks and benefits. Those will be determined by income, ability to pay premiums, and the value of other assets that the family wishes to preserve. The need for long-term-care insurance has become so prevalent that it should likely be considered a ‘required’ policy, similar to life, homeowner’s, and disability insurance. It is very important to have a trusted agent review elders’ financial situation carefully to ensure the proper amount of insurance coverage is purchased. A policy with at least five years of coverage may make it possible for elders to gift away some assets upon entering a nursing home.
Their care would then be covered by the insurance policy for the next five years, and upon termination of that insurance coverage, the elders will then potentially qualify for Medicaid. This type of planning must be done very carefully, preferably with the advice of a trusted elder-law attorney possessing specific knowledge and experience.
If you foresee a situation arising in which your parent will need your care, begin planning as soon as possible to assess the needs of all parties, hopefully before a crisis demands immediate action. This will bring peace of mind to you and your parents, and will assure the best possible chance of successful planning, health, and happiness for parents and children alike.
Attorney Hyman Darling is chair of Bacon Wilson’s Estate Planning and Elder Law departments. His areas of expertise include all areas of estate planning, probate, and elder law. He is a frequent lecturer on various estate-planning and elder-law topics at the local and national levels; (413) 781-0560; [email protected]