How to Talk to Your Elderly Parents about Assisted Living
I’m a geriatric care manager, and I recently turned 40. This means that my work, helping older adults and their families navigate senior care issues including assisted living facilities, has become personal, too. My parents are retired and starting to face some health challenges, and my friends are learning about the world of senior care as well. If this is you now, too, know that you’re not alone!
I often work with families dealing with urgent needs, but sometimes people ask me, “How do I gently encourage my parents to plan for the possibility of moving into assisted living or needing more care in the home?” I love questions like this because they show me that families are planning ahead instead of reacting to a crisis. One thing to keep in mind: The ideas of independence and control are extremely important at any age in our culture, but this becomes especially true in later years, when there are many major transitions related to retirement, identity, life routines, health, and relationships. I remind families that older adults are in the best position to maintain more control regarding their future when they plan ahead, express their wishes, and continue to talk when circumstances change. The more our parents can do to prepare now both financially and logistically, the more we can support their wishes in the future. Planning ahead will also help reduce stress, anxiety, and guess-work for you, too.
This is not a comprehensive list, but there are absolutely some things our parents can do now to think about what life could look like for them in the future:
- CARE NEEDS:
Are there any care concerns or diagnoses (physical, cognitive, mental) that might require additional care in the future? Do your parents already need help with any activities of daily living, such as bathing, dressing, maintaining personal hygiene, toileting, or managing medications? Once someone has an official diagnosis of dementia or no longer has the ability to transfer (get in and out of bed, or in and out of a wheelchair), the options for care in a community setting become much more limited, but remaining at home becomes much more difficult (and expensive) as well. Also think about how your parents handle instrumental activities of daily living, such as managing their own finances, driving, grocery shopping, preparing meals, using the phone (or other technology), housekeeping and laundry, etc. If they are unable to perform those tasks, how should they be handled…and by whom?
This is of course a huge consideration, especially here in Southern California. What will your parents’ finances allow? Will friends and family be pitching in with additional funds or providing some care? The more care they will need, the more they will have to pay, whether at home or in a community setting. It’s also important to consider an annual increase of about 5% in the cost of care. Also, many people think that remaining at home will be less expensive than moving, but that’s not necessarily the case, especially if your loved one needs 24/7 care. I highly recommend that your parents consult with their financial advisor sooner rather than later to start planning, as there are a lot of ways to finance retirement living – and unfortunately, Medicare and Medicaid cover far less than people think. Another good option is to consult with an estate planning or elder law attorney, as they can help your parents plan for Medi-Cal (California’s Medicaid program). There are very strict guidelines regarding spend-down for Medi-Cal, so I recommend that you or your parents speak with a professional before you make any major decisions regarding their home or finances.
What are some hobbies, interests, and activities that will continue to be important as your parents age? Do your parents appreciate privacy and solitude, or do they want an active social life? What’s working and not working about their current situation that can help them pinpoint services and amenities that they will value as care needs increase? If mobility is becoming more of a challenge, is their current home appropriate for them to age in place?
- OTHER DESIRES:
What’s your parents’ ideal scenario? What’s important to them? Do they want to spend a lot of time traveling, volunteering, playing golf, spending time with grandkids, or not ever cleaning the house again? Are they used to hiring help for various tasks, or do they shun the idea of someone assisting them? What kinds of decisions could they make now to allow those plans to come to fruition? As needs progress, it may not be possible for them to achieve Plan A, but perhaps Plan B can help them preserve what’s important to them, just in a different way.
Do they want to stay where they are now or potentially move to be closer to a family member? Is being near doctors, friends, or a place of worship important to their quality of life? Some states are a lot more retirement-friendly than others, due to weather, Medicaid eligibility, cost of living, etc.
- LEGAL DOCUMENTS:
Do they have a trust that’s been recently drafted or updated? Have they designated someone to have power of attorney for finances as well as health care? Have they communicated their end-of-life wishes to you or anyone else? These conversations are not easy, but trust me, they are easier to have before a crisis, when you’re just talking hypothetically! I’ve had many conversations with my parents over the years because it’s difficult to have just one conversation and then be done. It’s a process, and their priorities might change over time. So, it might be good to just schedule a time with your parents to start the conversation; that way, they aren’t caught off guard and can be thinking about their wishes ahead of time. Again, I also recommend that your parents consult with an estate planning or elder law attorney to give everyone peace of mind that when a crisis comes, you (or whomever they designate) are already prepared to step in and advocate for them if they cannot advocate for themselves.
This can be a tough one because then it starts getting real. Maybe you can ask, “What types of things would help us know when home might not be ideal for you anymore?” Or, “How can we help you remain as independent as possible, even in your later years?” Example: having a hard time navigating stairs, not being able to drive anymore, being burdened by maintaining the home, falling and needing assistance, etc. Discussing when they think it would be appropriate to bring in extra care or explore retirement communities will help you all know how to approach the conversation when the time comes. If you’ve had a chance to discuss their priorities and current/potential care needs already, you can build some concrete examples.
If you can gather as much information from your parents as possible, bring in professionals to help plan, and remember their desire for independence and control, you’ll be on your way to helping your parents maintain their priorities in life even as they need additional care.
Jill Love, MBA, MA, is a senior care consultant, geriatric care manager, and mom of two in Redondo Beach. She is the founder and president of Peters & Love and works with families to assess care needs, evaluate options, and create a plan of care. Her goal is to provide peace of mind to families by helping them navigate the world of senior care. You can learn more about her at www.petersandlove.com