December Surprises in New York City and Northern New Jersey

It’s an annual event. Adult children return to see their aging parents and they notice thing’s have changed. Even if you’ve been talking all year you might be noticing a real decline in house upkeep. Perhaps there are stacks of unpaid, unopened bills laying about. “Golly gee, that’s quite a gash in the rear fender you got there Pop.” says you. “Can you believe that SOB?! And, the insurance company’s not renewing MY policy?!”  says he. What’s the internet era acronym…? OMG! Yes Houston, we’ve got a problem, here. Whether you are in constant contact or not, stuff happens. Time’s marching on and it IS time to start thinking about things that may not have been considered up till now. They’ve aged. And, in one way or another, its showing.

First, don’t panic. If you’ve a sibling that you thought was on top of this, don’t attack. Many of these things are like watching hair grow. Its a slow process and its easy to miss it if you’re in regular contact with a person. Moreover, if you’re sib’s the kind to call a hurricane a drizzle, hold your fire. Nothing to be gained. Unless, you’re ready to relocate across the country to take over. As well, don’t get  confrontational with your folks. Either, they’re not noticing their hair growth or they’re aware but might have some sense of helplessness or shame going on. And when you decide you’ve got to “get them past their denial” or “get them to accept their situation”, you’re likely dealing with the same issues (shame, helplessness, etc…). Take my word on this.

The issues that need to be addressed are legal, housing, financial and… end-of-life.

So…, what to do? Pragmatism, clear thinking, problem solving is what’s called for. First, why bother. Sure, there’s a problem. But, you need to answer the real question “How’s the problem a problem?” You’re going to be responded to with statements like “I raised you. I’ve taken care of myself and your mother for a long time. Leave me alone.” True statements. But, here are some important points to come back with:

1) Avoid family conflicts– We want you to make the decisions. Unfortunately, problems can jump up where you won’t be able to decide and that will leave us guessing and arguing about what you’d like. Also, under the law, we may not even have a right. That right could belong to a strange judge. And, there are no shortage of strange judges out there.
2) It happens– And it happens fast. Falls, strokes, heart attacks, etc… Kick the can down the road today and tomorrow you could be out of road.
3) A little sneakiness is OK– “Hey Dad, I’m thinking of setting up a health care proxy. I’m confused. What did you do about yours? Should I use a lawyer, social worker, etc…?” See here you’re not confronting but asking for help. Making someone feel helpless is usually useless. Making someone feel helpful is irresistible. If you can get across how helping themselves is helping you and yours, you’ll likely do better.

Specifics

Legal– These are:

1)The Will: This is the document that tells the world what to do with what they leave behind. As in most things, these matters vary by jurisdiction (states). Lose the idea that if there’s no Will you can just pop over and start splitting up stuff as you and the family choose to “work it out”. For one, this would likely be the single largest cause of permanent family hostility. And, the world already has an answer to “no Will”. Its called intestacy. Its the body of law that spells out exactly who gets what when the deceased didn’t instruct otherwise in their Will. Refer back to my statement about strange judges.

2)Power of attorney– This is going to be the person/s you designate to manage non-health related affairs when you can’t (you can also have such a person/s handle matters when you can but don’t for various reasons). Once again, if you don’t specify this ahead of time in a legal document (ie., durable power of attorney), the world does not sit by while family members take control. They won’t be able to. Rather, its down to a judge again. He/she will appoint a guardian. This is an enormously complex and expensive process that is avoided by appointing a POA.

3)Health Care Proxy/Living Will– Its not enough for you to think you know what they want. Its not enough for your parents to think you know what they want. It needs to be on paper. Can’t be bothered? I have two words for you: Terry Schiavo.

Housing

How do they want to live? Time to bone up on the options. Its pretty complicated. There’s home-care, your house, assisted living, continuing care retirement communities, independent living and nursing homes. About the latter, don’t make commitments you cant keep. There are situations where there are no alternatives. OK, if you’re Rockefeller maybe you can pay private nurses at $150/hr to move in. But, in most cases, there can come a time where there’s no alternative to a skilled nursing facility. You also don’t want to over-promise due to conditions and limitations imposed by our next category.

Financial

Its important to know the limits of public services. Then you can explain it to your parents/grandparents. There’s Medicare, Medicaid and an alphabet soup of programs locally administered as the very fragmented, broken and torn up social safety net. Its not feasible to elaborate on what’s available locally. Likely, its minimal (even in the bluest of states). Basically, it’s down to Medicare and Medicaid. Medicare is the same all over the country. Its the health plan for elderly and disabled. I think its very good but it provides very little home-care in the form of a home attendant. During the current reforms, big questions exist as to how much home-care will continue to exist. Medicaid is the national health insurance that’s given out based on lack of income and other factors. This varies from state to state and often county to county within states. If you live in a metropolis near a state line (ie., NYC, Chicago, KC, etc…) this can provide more “interesting” variables. Finally, there’s private long term care insurance. This is something to consider seriously as it can add security in the unstable public entitlement environment we’re all in now. However, caveat emptor. For a long time, in the days of the products inception, insurers were noted to be liberal in their allocation of benefits. Now, with the product becoming more and more mainstream, insurers are becoming increasingly difficult. Whoduh thunk?

End of life

This is the stuff that is within the health care proxy. What do they want to occur or not occur at the end. Keep me alive as long as possible? Pull the plug? When? Under what conditions. What procedures are OK? What ones to avoid?

But they refuse to talk!!!

Yep. At the end of the day, that can happen. After all, they changed your diapers. Who are you? Maybe, you’re the “baby” in the family? Albeit, you’re 55 and running a company with 100 employees and you’re older more respected sib missed Dad’s bumper dragging behind the car (“its been that way for years!!!”). You’re still the baby. Its time to call for reinforcements. This could be a professional (lawyer, social worker, geriatric care manager, clergy, etc…). Could be friends, distant family, neighbors. It could hurt not being accepted as the person to fix this problem. But, if you get this done whilst waiting in the wings, you did do it. The point is, get it done.

For additional information or assistance, please visit us at:  www.northstarcare.net.