As Mom and Dad get older many will start to lose their independence. Often, this leads to the need for Long-Term Care services and supports. This usually starts with reliance on family members for help with normal living activities. This usually means one son or daughter, or a daughter-in-law, becomes responsible for this support. This is where conflict can arise among siblings.
There are two types of normal living activities. Activities of Daily Living (ADLs) & Instrumental Activities of Daily Living (IADLs) are the main tasks that the elderly, or those who have significant health issues, must manage to be safe and independent.
The generally accepted ADLs are:
- Walking, the ability to move around the house or outside. Health professionals may call this “ambulating.”
- Feeding, the ability to get food from a plate into one’s mouth.
- Dressing and grooming, this is the ability to not only select appropriate clothing but the ability to put those cloths on safely and adequately keeping up one’s personal appearance.
- Toileting, the ability to get to and from the toilet, using it properly, and cleaning afterward.
- Bathing, the ability to was one’s face and body in the bathtub or shower.
- Transferring, is the ability to move from one body position to another like from a bed to a chair, or onto a wheelchair.
Some people need “stand-by assistance”, meaning they can still perform the task but another person needs to be around ‘just in case’. Others are fully dependent and require another person to complete the activity for them.
IADLs are Instrumental Activities of Daily Living. These tasks we start to learn as young teenagers. They require more complex thinking and organizational skills. They include:
- Managing finances, the ability to paying bills and managing finances.
- Managing transportation, the ability to drive or find other means of transportation.
- Shopping and meal preparation, the ability to get a meal on the table, shopping for groceries, clothing and other items required for daily living.
- Housecleaning and home maintenance, the ability to clean the kitchen after eating, keeping a home clean and organized, and keeping up with normal home maintenance.
- Managing communication, such as the telephone and mail.
- Managing medications, the ability to take medications as directed.
These ADLs and IADLs are used to evaluate a person’s ability to function. When they can no longer function due to illness, accidents or the impact of aging, some form of long-term care services and supports will be required. If a person does not have Long-Term Care Insurance the responsibilities fall to family or paid caregivers, or both. Health insurance, Medicareand MedicareSupplements will only pay for a small amount of skilled services. They pay nothing toward long-term custodial care, which is the type of care most people require.
Dealing with a parent’s care is usually stressful and usually falls on to one person’s shoulders. This can reawaken old sibling rivalries and lead to discord. Often, this can tear families apart leaving the person needing care feeling guilty. Each family member usually has their own careers, families and responsibilities. Concerns over time management and money can make the most loving family miserable.
There are numerous reasons these conflicts occur. The top two are the “fairness” of the time requirements and money, or the draining of money which will no longer be in the estate for inheritance.
When one family member is the primary caregiver and manager of care for Mom or Dad a sense of resentment sets in. This can happen either very quickly or over a period of time depending on the amount of help Mom or Dad requires.
Some siblings get “off the hook” because they live far away. Others have “important” jobs which require substantial amount of time. When the primary sibling asks for help they are often met with resistance. On occasion, the primary sibling doesn’t communicate what they are doing to others in the family. That leads to a feeling or not being involved. These other family members may “wash their hands” of the situation.
You might think you and your brothers and sisters (or you and your own children) will not fight about these issues. However, when you consider the time requirements of being a caregiver and the money … or the draining of assets and the reduction of a future inheritance, don’t be fooled how this will impact them, their spouses and the overall family relationship.
With many people not able to save much money, they look to Mom and Dad to leave them money when they pass. The problem is long-term care happens too frequently and many people have not planned to address these costs and burdens. The bottom line means family caregivers face tremendous physical, emotional and financial issues or paid care drains savings and reduces, or eliminates, a future inheritance.
It might be noble to think your family is not motivated by money over family, but the reality is money is often a dominating concern and it creates a problem within even very close families.
Being a family caregiver is demanding on its own, but when you combine perceived unfairness of time and responsibility between family members with money and inheritance, it can create animosity between siblings. When one sibling feels unjustly overburdened with a parent’s care, money can compound the conflict.
What can you do? You really have two issues. The first is to resolve the conflicts with family members as elder parents require care. Those issues can be easily avoided before they become a problem by advance planning. That plan should include Long-Term Care Insurance. But depending on age and health you must get in crisis management mode.
Dealing with Elder Parent’s Care Now
Parents often resist help when they are both living. This often becomes a bigger problem once one parent passes away. One family member will often say, “Dad made me promise to never put Mom in a nursing home.” They become almost martyr-like by saying they will allow Mom or Dad to come live with them. Generally, this is not a good idea and starts the family on a road to family bitterness.
A family meeting, perhaps with a geriatric care manager, can provide you with a quality plan of care based on Mom or Dad’s situation. The care manager is trained to assess, plan, coordinate, monitor and provide services for your Mom or Dad and to help the family at the same time.
Get your older parent involved in their care is important if they are able. Making sure each family member discusses their concerns and limitations openly help other siblings understand. Each family member has their own career demands, family demands, and other responsibilities. Some siblings will be more flexible than others. This doesn’t mean one family member cares more or less than another. It is just the reality in which you live.
Use each brother or sister (or their spouses) talents to best fit Mom or Dad’s needs. If a sister is a lawyer use that talent to address medical power of attorney and other legal issues, for example.
If assets are available, hire quality caregivers and reduce the physical burden of being a caregiver. Yes, this will drain savings, but Mom or Dad will get better quality care and the physical demand will be lessened.
Communication is key. Be sure the whole family understands what is happening with Mom or Dad’s health, caregiving, and finances. Don’t hide information since it will come out eventually. By keeping everyone informed there will be less strife between siblings.
If money runs out, Medicaid, the medical welfare program, will pay for long-term care.
The goal is to try to keep family as family.
There are several legal documents that once you hit age 50 people should have in order to take the guesswork out of their care wishes. Make sure your Mom and Dad (as well as yourself) have these in place:
- Will. Don’t expect people to know what you want to be done with your assets, spell it out. Include special items like rings and other jewelry.
- Power of Attorney for Health Care. Designate a person who will make decisions when a person becomes mentally or physically incapacitated. Be sure to include a successor in the event the primary person is not able to be contacted.
- Living Will. These are advance directives documents that help the family ensure that a person’s desires are met. This is especially important for end-of-life decisions. If a person’s wishes are very specific be sure to include a letter to attach to these documents.
- Power of Attorney for Finances. This allows a person to be designated to act on your behalf to pay bills, sell funds, etc. when a person is unable to do so themselves.
Now Deal with Your Future Care
If you are in your 40s or 50s this is the best time to plan for the financial costs and burdens of aging. You should already have in place savings plans like a 401(k) 403(b) IRA or SEP. You need to protect those assets from your future long-term care needs. In addition, your plan will reduce the burdens placed on your children and their families in addition to protecting assets.
In addition to the legal documents above you should have a Long-Term Care policy in place. Since you must health qualify in order to buy a plan, do so before your health starts to change. Each insurance company has different underwriting standards so be sure to speak with a specialist in this area and not a general insurance agent or financial advisor who will have much-limited knowledge.
Even a small policy will help your family and allow them to have better relationships as you age. Many states offer partnership policies which provide additional asset protection. Be sure to ask. Premiums are based on the age and health at the time of application in addition to the amount of benefits a person wishes to have. These are custom designed to make sure you get solid recommendations.
Find the costs of care, availability of partnership plans and any tax incentives that might be available in the state you live in or you plan to retire to down the road - LTC News Map - Find Your State.
Just remember, all family members are on the same team. Advance conversation and planning will make it easier for everyone.