December 15, 2022
Robert Gaan, CFP®
My mother, Frances, is 96 years old. We call her Granny Franny. She has lived an amazing life. Born in Shanghai, China, she survived the Japanese occupation and the communist revolution. She and my father immigrated to the US with not much more than their hopes and dreams. She raised a family while working as a secretary for the Mobil Oil Company. Having grown up in wartime, she had no opportunity to get a formal education. So, after retiring, she started taking classes at the local community college and earned her high school diploma at age 70.
While she remains in great shape and continues to live independently, she is beginning to slow down. She has started using a walker and the family convinced her to stop driving as a service to the general public. A little over a year ago, Franny moved from Sonoma County in the Bay Area to an independent living community in my home town of Encinitas. As a result of her move, I have become more directly involved in her oversight and care. Over the past year, I have learned a lot about what it takes to effectively monitor and assist an aging parent. Here are some takeaways and action items for you and any senior in your life:
Estate Plan and End-of-Life
You should be confident that your senior’s estate plan is in order. We recommend at minimum that you have a copy of their will or living trust. If you are not the executor of their will or successor trustee of their trust, you should be in touch with who is. In addition, we also recommend you explore the appropriateness of the following:
For many seniors, this document is difficult to draft because it requires them to face their own mortality. Also known as an advance health care directive, a living will is a legal document in which the senior give instructions regarding their preferences for medical care in the event they are unable to make decisions for themselves. Living wills provide guidance for doctors and caregivers in instances such as terminal illness, coma, late-stage dementia or end-of-life care. A living will can relieve loved ones and caregivers of having to make what could be agonizing decisions. It can also help minimize confusion or disagreement about the choices the senior would want people to make on their behalf.
A do-not-resuscitate order instructs medical personnel to not perform CPR on a patient who has stopped breathing or whose heart has stopped. This order may be appropriate for a terminally ill patient or one whose chances of survival are low. Patients are required to consult their physician before putting a DNR in place (because DNRs are typically not effective until the physician also signs it and places it in the patient’s medical file).
A POLST (Physician Orders for Life Sustaining Treatment) goes a step further than the DNR. A POLST might include DNR instruction regarding CPR, but it also provides instructions to physicians, nurse practitioners, physician’s assistants, and emergency medical services workers regarding limits to other forms of life sustaining medical treatment (for example, IV fluids).
Assisting with Finances
If your senior is open to sharing financial information, a list of their monthly bills and on-line access to their accounts can be extremely useful so you can track or make payments. Having this access, if it should suddenly become necessary, can prevent a sizable disruption to the movement of money and processing of bills. (In fact, it is advisable to ask for a list of all your senior’s user online login and passwords.) Review this information at least annually to make sure the list is up to date. If your senior is currently paying bills in person or by mailing checks, we recommend helping them set up online access and auto-pay to make the process easier. For a more formalized financial role, a POA for finances might be in order.
Durable and Springing Power of Attorneys (“POA”) for Finances
One of the benefits of establishing a living trust is ease of administration and continuity should your senior become incapacitated. However, IRA, other retirement accounts, and accounts held solely in someone’s name (not their Trust or jointly) are not governed by the terms of a living trust. Only the account owner can request funds from their retirement account or give direction as to how it is to be invested. There is also the question of vendors (cell phone, cable/internet, utilities, etc.). Those entities will only talk to and take instruction from the account owner. That is why a durable power of attorney is so important. A power of attorney is a legal document that lets your senior nominate an agent to whom they grant the power to act in their place, make decisions and transact business on their behalf.
A durable power of attorney (DPOA) is a type of power of attorney that remains in effect even if the person who created it becomes incapacitated. In some cases, however, seniors are fully capable of handling their own affairs but would like to plan for unexpected incapacity. These individuals can draft a “springing” power of attorney document instead. A springing power of attorney grants the agent the power to handle the senior’s affairs only if the senior becomes incapacitated. In other words, a DPOA is always "on" and can be used immediately, while a springing POA only "springs" into action when certain conditions are met.
Aging-in-Place or in Assisted Living
In caring for Franny, I have uncovered some helpful tips related to aging-in-place and also with Assisted Living:
Consider home safety: install grab bars near toilets and in bathtubs/showers; remove trip hazards like throw rugs; remove excess furniture/clutter so that walkers can be used throughout the entire home; install chair lift to reduce the risk of stair falls.
Keep a caregiving notebook to help track your senior’s physical and cognitive abilities and needs as time passes.
If your senior is amenable, keep a list of prescriptions including the name of doctor that prescribed the medication, dose and usage instructions. Review it periodically to make sure it stays current.
Medical Alert Devices – These “I’ve fallen and I can’t get up” devices are very effective IF worn consistently. Franny did not like wearing her original device, which was attached to a necklace. A staff member at Franny’s senior community suggested we switch to a bracelet which she likes better and wears regularly.
Take a moment and think through all the possibilities. For example, we have a client who has a parent who lives in an area that is subject to rolling power outages during periods of peak electricity usage. The client’s parent depends on a medical device that requires power to operate. Our client arranged for a backup generator system to be installed at the parent’s home to ensure that all essential equipment can remain operational at all times.
Socialization is critical for seniors’ physical and cognitive health. For Franny, one of the benefits of living in an independent living community is access to organized social events. She loves flower arranging, watercolor painting, bingo and field trips to local eateries and activities. For seniors still living at home, check out senior day care activities at local community centers or inquire about senior companion programs in the area.
Caregiving means caring for yourself as well:
For many, caregiving for a senior is an added responsibility on top of their job and their immediate family responsibilities. It is important to assess your capabilities and ask for help if needed. Be realistic and consider asking for help from family, friends, and trusted neighbors.
A Geriatric Care Manager is usually a registered nurse or a social worker who is a senior advocate. The care manager knows how the care system works and can help identify needs and develop a plan of care as well as be a liaison between the family and the senior’s medical providers. Geriatric Care Managers work especially well when family members live far from the senior.
HIPAA Authorization Form
Having taken Franny to a number of doctor appointments over the past year, I learned very quickly about HIPAA Authorization Forms. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that created a series of standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge. I could not speak directly to Franny’s doctor about her care without a HIPAA form in hand.
Durable Power of Attorney for Healthcare
Just like a POA for Finances, a POA for Healthcare enables your senior to name a person to make decisions about their medical care if they are unable to do so themself.
Finally, and perhaps most interestingly, caring for a senior offers you an opportunity to learn more about your family history. Franny’s nearly century-old legacy deserves to be recorded and preserved. Knowing that time is of the essence, I look for interview opportunities often. I’ll ask her questions when we are driving to a doctor appointment or grabbing a quick lunch after church. My smart phone serves as a convenient recording device. From my research, I’ve learned to ask open-ended questions like “What do you remember about where you grew up?” or “If you could go back to any age, what would it be?” Her answers are priceless and serve as sources of amazement, pride, laughter and wisdom.
Both the National Institute on Aging (https://www.nia.nih.gov/) and the National Council on Aging (https://www.ncoa.org/) websites offer a wealth of information for those seeking to learn more about caregiving for seniors. As always, feel free to reach out to me or any other WEIL advisor for additional insight. On behalf of the entire WEIL team, I wish you and your family a wonderful holiday season and a happy and healthy new year.
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