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How to Plan, What to Do, and Where to Turn When Caring for your Aging Parents—and Yourself

“There are only four kinds of people in the world:

Those who have been caregivers;

those who currently are caregivers;

those who will be caregivers;

and those who will need caregivers.”

—Rosalyn Carter, former First Lady of the United States and
President of the Board of Trustees, Rosalyn Carter Institute for Caregiving

Dear Friends,

Caring for your aging parent is one of the most loving gifts you can give—and perhaps one of the most difficult jobs you’ll ever have. I know. From first-hand experience. 
I’m one of hundreds of thousands of Long Islanders in recent years who have taken on the tasks of caring or finding care for an older relative or friend. My three brothers and I took care of our mom, a brave and remarkable woman who successfully aged in place before eventually succumbing to Alzheimer’s. We went through practically every phase of caregiving: helping our mother stay safe and independent for as long as possible; then managing the complex process of long-term care legal and financial planning, overseeing a wide variety of services as Mom became increasingly frail, from choosing home care aides and adult day care programs, to overseeing doctors’ visits, wound care and sub-acute rehabilitation services, physical therapy and other in-home health-care providers; and finally, engaging hospice care. 
I’m one of hundreds of thousands of Long Islanders in recent years who have taken on the tasks of caring or finding care for an older relative or friend. My three brothers and I took care of our mom, a brave and remarkable woman who successfully aged in place before eventually succumbing to Alzheimer’s. We went through practically every phase of caregiving: helping our mother stay safe and independent for as long as possible; then managing the complex process of long-term care legal and financial planning, overseeing a wide variety of services as Mom became increasingly frail, from choosing home care aides and adult day care programs, to overseeing doctors’ visits, wound care and sub-acute rehabilitation services, physical therapy and other in-home health-care providers; and finally, engaging hospice care. 
Every family’s caregiving journey is different—but practically everyone can tell you their saga of challenges and crises. Many adult children are wedged in the “sandwich generation”—holding down jobs while trying to manage the care of both elderly parents and their own children. They’ve told me that what they need most is a practical guide about what reliable resources are available to help them, especially during times of extreme stress and uncertainty. They need a strategic “roadmap” to help them navigate through the maze of care options.

This guide is intended to do just that—to empower you, the family member, in deciding how best to care for your loved ones. Long Islanders deserve up-to-date information about resources across the nation, but especially those close to home. This guide is organized in five parts to help you focus on the most critical issues at each stage of caregiving:

1. Preparing for care. Planning family conversations, reviewing benefits, insurance coverage, financial resources and legal documents.

2. Supporting those who are largely independent. Preparing the home for successful “aging in place,” including home modifications for safety and comfort.

3. Providing care for those able to live at home, with assistance. Explaining options, government benefits, levels of service, assistive devices and case management.

4. Providing care for outside the home. Making long-term care choices when it’s no longer feasible for loved ones to remain at home.

5. Caring for the caregiver.  How to take care of yourself, alleviate stress and find support groups and programs.

Supporting family caregiving is part of my broader work, promoting intergenerational activities that help older and younger generations learn from each other and honor what each has to offer. We all need to be engaged in caregiving. Indeed, when we discover better ways to provide care for our aging parents and friends, we are also forging new paths of care for our future selves. 
Sincerely,
Ron Roel
President, Roel Resources​

PART I

PREPARING A PLAN

Part I:    Preparing a Plan

The Family Conversation #1

Planning Across the Generations

​Providing good care not only requires advanced planning, but thoughtful, ongoing conversations between adult children and their loved ones.


These are not easy conversations. They cover complex subjects, ranging from financial and health issues to estate planning issues—topics that parents may be reluctant to discuss. And they’re emotional issues, forcing us to acknowledge that while we’d all like to see our parents as robust and independent persons, the odds are they will need our care at some point.


Too often, families avoid such conversations until a crisis arises—a fall, an accident or serious health diagnosis. Making big decisions in the midst of emotionally trying circumstances, however, is never a good strategy. No matter the challenges or reluctance, it’s better to talk when your parents are healthy, sharing information and weighing options and preferences before a crisis happens.


So how do you start?


Setting the Scene


Everyone’s situation is different. You could decide to bring up these topics informally or in a formal, planned meeting, whichever seems appropriate.

  • Set aside time to meet during holiday visits or other family occasions, especially if some adult siblings live far away. There may be an opportunity to start the conversation casually by discussing someone else’s situation—a person the family knows who may be having health problems or even some celebrity in the news who is aging. You might tell your loved ones that you’re thinking about your own retirement and ask them, “How have you planned ahead, and do you feel prepared?”
  • If circumstances don’t offer a natural opening, tactfully bring up the topic. Suggest that while no one likes to think about getting older and needing help, that’s not realistic, so perhaps the family could begin exploring potential plans as way of ensuring that your parents get help when they need it—in ways they want to be helped. Ask your parents, “Can we look at this together?” Reassure them that having the conversation does not mean that changes are imminent, or maybe ever. 
  • Frame the conversation in a supportive way, reminding your parents that this is about their wishes. Like many elders, your loved ones may be reluctant to have “the conversation” until a catastrophe occurs. No one wants to give up their independence and many will fight tooth and nail to protect it — even if it means personal discomfort. You can’t force your parents to discuss these things. As life’s roles shift, they’re still our parents. No matter how “adult” we are, we’ll always be “the kids” to them.
  • Consider enlisting the help of a trusted outsider, like a financial advisor, doctor or clergyperson. Your parents may feel more comfortable broaching these topics with them, rather than their children. That’s OK—you just want to begin the conversation with someone your parents will listen to, creating a bridge to their children.


Despite the challenges, families that work together usually find that it relieves anxiety and enhances their relationships. It’s hard to create a good caregiving plan for your parents without building a team, especially with the people closest to them.  If family members take the time to explore things early, they’ll likely avoid facing serious conflicts later. It can’t be too soon, but it can be too late if a health crisis occurs. The longer you wait, the fewer options you have, and you may find yourselves forced to make decisions without any idea what your loved ones may have wanted.


Having the Conversation


How you conduct potential caregiving conversations will depend on your family dynamics, of course, but here is a list of suggested tips from geriatric care experts:


  • Let your parents start the conversation—and let them talk with each other.
  • Don’t interrupt. Respect their time and thought process.
  • Don’t have this discussion when family members are tired or emotional.
  • Avoid drifting into old hurts; stick to specific issues at hand.
  • Ask questions and listen. Be open to your parents’ response—you might not know them as well as you think.
  • Don’t make decisions ahead of time; allow the conversation to go where it will.


Once your parents have had a chance to express their thoughts, you and your siblings can share your views. Be honest about your own concerns. Are you worried that your parents aren’t safe? That they don’t have enough access to friends and social activities?  If one of your parents is already caring for the other, are the caregiving duties too much? And if your family assumes that the adult children will be the “default plan” when it comes to parental support, what impact will that responsibility have on the caregivers’ jobs, children and other responsibilities?


Be methodical in your approach, but don’t worry about not trying to cover everything at once.  Again, stay respectful. Never give the impression that you want to “take over.”



The Sibling Syndrome


If you’re lucky, all your siblings will agree on the planning process. But that’s often not the case. When siblings fight, it can end up a war, and in some cases, sadly, they end up never speaking to each other again once mom and dad are gone.


To help families avoid such situations, siblings and parents need to talk openly about family history and dynamics, and how they might affect caregiving plans. Old roles and patterns from childhood may re-surface, creating contentious meetings and awkward choices. Don’t expect a sibling to see your parents as you do. You’re affected by how each of you related to them growing up, yet those past roles should not continue to define you today—especially in the context of your parents’ caregiving needs. To help navigate emotional disagreements, therapists often recommend that siblings try a simple semantic technique: Use “I feel” sentences, speaking from your own experience and perspective, rather than “you” sentences that may make your brothers or sisters defensive or angry.


While a care plan should be a shared responsibility among siblings, realistically, one sibling frequently ends up as the primary caregiver. This role should not default to the person who lives closest, but delegated to the one who is most skilled, willing and emotionally prepared. Siblings should evaluate what each of them could reasonably and honestly do. And if the burdens are disproportionate, talk about how each can contribute—perhaps with respite care, assistance in navigating entitlement benefits, or managing financial assets and estate planning.


The primary caregiver, in turn, must:

  • Respect the opinions of all those involved in the plan.
  • Share all information, keeping everyone up to date on their parents’ condition.
  • And keep everyone abreast of care issues through regular communications, such as email, texts, conference calls, and in-person meetings.


These conversations may not always be pleasant, but if you take the time to address issues early, you’ll likely avoid more serious conflicts later—and hopefully keep your family intact.


Making a Plan


While there is no one “right” caregiving plan, there are common issues.

  • First, the plan should center on your loved ones’ wishes. Don’t take decisions out of their hands.  As long as they are able to do so, let them steer their own ship, choosing how they’d like to live their lives and who they want to handle their finances, health and personal affairs.
  • Put the care plan in writing, especially if any siblings are missing from these conversations. It may be helpful to chart out your parents’ goals and requirements; the steps required to provide them, and the people assigned to each task. While family members are likely sources of support, don’t overlook friends, neighbors, and organizational affiliations as potential resources.
  • Set up a communications system that keeps everyone in the loop. And remember, the plan is just a draft. As your loved one’s circumstances change, plans will evolve to meet their immediate as well as long-term needs. You may not decide on a number of key issues, but at least you’ll know what your parents’ priorities are and will have reached some common ground.
  • Consider bringing in a third-party expert to help smooth communication if these conversations prove difficult. Mediators, family therapists, elder law attorneys, geriatric care managers and financial advisers—all these professionals can help family members get on the same page. They may charge for their services, but it is usually money well spent—an investment in the well-being of the entire family.


Even if the conversation does not go smoothly, you will have accomplished something: The seed has been planted. Your parents may not respond much initially, insisting, “We’re fine, thanks, we don’t need help.”  But you’ve probably gotten them thinking and they may even restart the conversation themselves as they face new experiences. Consider this the first of many conversations. The whole point of talking early in the game is to create a plan, so you don’t have to face an emergency without the information you need.


Helpful resources to help jump-start these ​early family conversations:

Several websites that offer useful information for caregivers nationwide

A short list of suggested topics to help keep you focused on the family’s plan

ASSEMBLING VITAL DOCUMENTS

One of the most important tasks for families is to make sure that important information relating to their elderly loved ones is accessible. Gathering and organizing may take more than a day, but working together will make it easier, and your entire family will feel more secure when the papers are in order. Try breaking the task into a few steps:


1. Identify where your parents keep their important papers. It may be at home, in a file cabinet or safe, or in a safety deposit box, or with their attorney—or all those places. It doesn’t do any good to have your parents records in order if no one knows where to find them.


2. Sit down as a family to review all relevant documents and accounts. Identify missing links—information gaps you need to fill in to help your loved ones plan for retirement, as well data or contacts you might need in a medical emergency. Make sure designees and beneficiaries are up to date for all policies and accounts.


3. Come up with a checklist of all the documents. Note which ones you need to keep together in a safe place, such as a secure file cabinet, so you can locate them quickly when needed.  Keep original documents, such as passports and birth certificates, in a fire-proof safe.


4.  Make sure you know who is authorized to speak to company or government agency representatives, in case your loved ones can’t speak for themselves. Make copies of key documents for the person(s) designated as Power of Attorney and Health Care Proxy. 


5. Consider electronically scanning files onto a memory stick that can be stored at another location. Remind your parents to update their documents every three years.


6. Don’t forget to keep a record of your parents’ “virtual estate.”

These records may include digital photos, social media, online records, financial and other accounts, including user names and passwords.


7. Make a “contacts” file with the names of all key people in your parents’ lives. Make it easy for your family members to locate these important people—close relatives and friends, primary physician, minister/priest/rabbi, attorney, accountant, tax preparer, and banker.

Here is a suggested list of vital documents and information

ADDRESSING ELDER LAW NEEDS




Consulting an Elder Law Attorney

Assuring the future care of an aging family member usually involves making important decisions about legal, financial, health care and estate planning options.  Not everyone may need an elder care lawyer, but these professionals can help multiple generations of families plan how their health care and financial wishes will be carried out, including the execution of key legal documents such as health care proxies, living wills and powers of attorney. An attorney also can assist in planning for possible long-term care needs, including Medicaid options, as well as review wills, create trusts and design estate plans to preserve assets.

Family caregivers should be aware that if their parents hire an elder law attorney, the attorney represents the interests of senior clients —not their adult children. The attorney’s goal is to make sure that good care is provided and see that the senior’s assets are preserved as much as possible, and not necessarily for the sake of the children’s inheritance.

So how do you find a local elder law attorney?  As with the hiring of other professionals, like accountants, start with referrals from people you trust, such as close friends, business associates, financial advisers and health care professionals.  Also consider these sources:

Here is a listing of several websites that offer help in finding an elder law attorney 


Once you’ve assembled a short list of attorneys, check each candidate’s background (most likely individual credentials will be listed on the firm’s website) and request a brief interview. Confirm their background, experience and credentials:

  • How long has the attorney been in practice?
  • Is the attorney a member of the National Academy of Elder Law Attorneys?
  • Is the attorney a member of the elder law committee of the state or local bar associations
  • Is the attorney a member of organizations such as the Alzheimer’s Association or the American Parkinson Disease Association?

Then, ask a series of additional questions:

  • What percentage of the attorney’s practice is involved with elder law?
  • Does the attorney speak or write frequently on the topic of elder law?
  • What is the fee for the first consultation, and what information or documentation should you bring to that meeting?
  • How are the attorney’s fees assessed for additional consultations, as well as the execution of wills, trusts and other legal documents?
  • Can the attorney refer you to a handful of his or her clients?

An experienced elder law attorney can be a valuable asset for seniors and their caregivers, helping to explain complex regulations, identify unforeseen alternatives and potential family conflicts—before they become crises.

PUTTING KEY LEGAL DOCUMENTS IN PLACE




THE CORE FOUR


There are four important legal documents for caregivers and their elderly loved ones: two relating to medical decisions (the health care proxy and living will), known as advance directives, and two relating to financial issues (power of attorney and will).

Your parents should have a conversation with you and your siblings about these documents so that it’s clear what their wishes are, who in the family has been designated to assume various roles—and that they’re willing to serve in these capacities.  Make sure you know where these documents are stored and that your loved ones provide copies to their doctor, elder law attorney, and other family members, as needed.

Most experts recommend that your parents consult an elder law attorney when completing these powerful documents—and you should, too, when doing them for yourself. Review these directives every few years, since changes in state law, as well as changes in personal situations—such as divorce, relocation, or death in the family—can affect how the provisions of legal documents are carried out.


A. Health Care Proxy


This document allows your loved ones to appoint an “agent,” typically a trusted family member or close friend, to make important health care decisions for them if they become incapacitated and unable to make such decisions for themselves. In New York, a health care proxy does not have to be notorized, but the form must be signed in the presence of two adult witnesses, not including the agent.


Actually, everyone over age 18—including adult caregivers and their grown children—should appoint an agent who can make health care decisions on their behalf, in case something unexpected happens. A health care agent can be your voice, someone who makes your health care decisions according to your own wishes, or your best interests.


In a health care proxy, the agent may be given limited or broad authority, including instructions about the types of medical treatments a person wants to receive if they are either temporarily or permanently unable to make their own health care decisions.  Hospitals, doctors and other health care providers must follow an agent’s decisions as if they were the care recipient’s own. If someone does not have a health care agent, all appropriate medical treatments will be provided to that person.


To obtain a sample health care proxy form:


Go to the New York State Department of Health website (www.health.state.ny.us) and search for  Health Care Proxy. Or write and enclose a stamped, self-addressed envelope to:

New York State Department of Health—Health Care Proxy
P.O. Box 2000
Albany, NY 12220

   
B. Living Will


A living will is a document that specifies what types of medical treatments your loved ones desire should they become incapable of expresses those desires. It must be signed in the presence of two competent witnesses over age 18.


People may wish to receive or refuse specific treatments under certain circumstances, most commonly a progressive or terminal illness or permanent disability. A living will should be clear and follow verbal instructions that have been given to family and friends.  It can include instructions concerning the termination of life support.


If a person does not have a health care agent, a living will is better than having no advanced directive at all. Still, there is no statute in New York that governs living wills. The highest state court has ruled that a living will is valid as long as it constitutes “clear and convincing evidence” of your wishes. But there is no standard living will form, so even a well drafted document is ultimately subject to interpretation, and it’s hard to provide specific instructions to cover all possible future events. It’s especially important, then, for you and your parents to consult with an attorney to make sure that their wishes are stated in the most effective manner possible.


A sample living will form is available on the New York State Bar Association website (www.nysba.org/downloadforms Click Elder Law.)


In addition, if your loved one has serious health conditions, caregivers should consider another critical document, known as a MOLST (Medical Orders for Life Sustaining Treatment). These medical orders, including instructions regarding “Do Not Resuscitate Orders” or “Do Not Intubate Orders,” are intended to honor a person’s wishes and preferences in providing quality and-of-life-care. (See more information in Part IV, “Long-Term Care & Supportive Housing.”) The MOLST form (which should be printed out on bright pink heavy stock paper) is available on the New York State Department of Health website (www.health.ny.gov; search for “MOLST”).


C. Power of Attorney

This document gives an “agent” broad powers to take care of certain business or financial matters on behalf of another person, known as the “principal.” The principal, most likely an older parent, does not need to become incapacitated for the power to be triggered. Agents must act according to the instructions of the principals, or where there are no instructions, in their best interest of the principals.


In New York State the principal must sign a power of attorney in the presence of a notary and does not become effective until it is signed by the agent. That authority ceases, however, upon death of the principal or revocation of the power.


There are three types of Powers of Attorney:


A nondurable power of attorney takes effect immediately and remains in effect until the principal revokes it, becomes mentally incompetent, or dies. It is often used for a specific business transaction, such as the sale of a property, or the handling of financial affairs while the principal is traveling and unavailable to take care of them.


A “durable” power of attorney may be used immediately and remains in effect until the principal revokes it or dies. It enables the agent to act if the principal becomes mentally incompetent or is physically unable to make decisions.


A “springing” power of attorney becomes effective at some future time and remains in effect until the principal’s death, or until it is revoked by a court. This POA is often triggered by a specific event identified by the principal, such as an illness or incapacity, and initiated when the principal’s physician declares the principal not competent to manage their own affairs.


There are many online resources like the New York Bar Association that offer free templates to consider when drafting a power of attorney (www.nysba.org, click News & Publications, then Downloadable Forms, then Power of Attorney Forms). Nevertheless, a POA should be executed under supervision of an attorney to ensure that areas of authority are clearly defined and understood by both parents and caregivers—including recent changes in the law regarding major gift provisions.


D. Will


A last will and testament is a legal document that helps individuals ensure that their assets and estate will be distributed according to their wishes when they die. In New York a will must be signed in the presence of two competent witnesses over age 18. This document enables someone to choose an executor to manage and distribute their property. Without a valid will, a person’s property will pass to those relatives specified by law through the court system.


While not related to the immediate financial aspects of caregiving, serving as the executor of a parent’s will is often an important part of a family caregiver’s long-range responsibilities.

ASSESSING FINANCIAL RESOURCES



If you’re like most families, your parents have probably put together some kind of financial plan for their later years, whether or not they decide to “retire.” Still, it’s important to be familiar with their plan, because ultimately, you may end up being in charge of their finances as part of your caregiving responsibilities.

Caregivers can help their loved ones conduct a “financial checkup,” especially when it comes to assessing two major areas of financial concern:  housing and health care costs.

First, find out if your loved ones have a financial adviser—one who is a “fiduciary,” a trusted investment adviser who is required to act in the best interest of the client at all times, not just offer products that are “suitable” for them. (As of October 1, 2019, all advisers with the designation of Certified Financial Planner will be bound by new standards set by the industry’s Certified Financial Planner Board of Standards.) This adviser can act like a quarterback, working with your parents’ accountant, banker, estate attorney and other professionals to help them plan their future. The Financial Planning Association (www.plannersearch.org)  has a registry service that can be used to search for names of Certified Financial Planners in your area.  And you can learn more about the financial planning guidelines and resources at www.letsmakeaplan.org.


Visualizing these later years is not unlike planning a vacation: Your parents (and ultimately you, too) need to pick a destination—how do they want to spend their time and where—then meet with the financial adviser and map out how to get there. Granted, there are many unknowns, but caregivers can encourage their loved ones to create a written plan, so the family can assess their resources for caregiving.


Consider the basic steps—which could apply to multiple generations—listed below:



If you’re like most families, your parents have probably put together some kind of financial plan for their later years, whether or not they decide to “retire.” Still, it’s important to be familiar with their plan, because ultimately, you may end up being in charge of their finances as part of your caregiving responsibilities.

Caregivers can help their loved ones conduct a “financial checkup,” especially when it comes to assessing two major areas of financial concern:  housing and health care costs.

First, find out if your loved ones have a financial adviser—one who is a “fiduciary,” a trusted investment adviser who is required to act in the best interest of the client at all times, not just offer products that are “suitable” for them. (As of October 1, 2019, all advisers with the designation of Certified Financial Planner will be bound by new standards set by the industry’s Certified Financial Planner Board of Standards.) This adviser can act like a quarterback, working with your parents’ accountant, banker, estate attorney and other professionals to help them plan their future. The Financial Planning Association (www.plannersearch.org)  has a registry service that can be used to search for names of Certified Financial Planners in your area.  And you can learn more about the financial planning guidelines and resources at www.letsmakeaplan.org.


Visualizing these later years is not unlike planning a vacation: Your parents (and ultimately you, too) need to pick a destination—how do they want to spend their time and where—then meet with the financial adviser and map out how to get there. Granted, there are many unknowns, but caregivers can encourage their loved ones to create a written plan, so the family can assess their resources for caregiving.


Consider the basic steps—which could apply to multiple generations—listed below:







FINANCIAL RESOURCES CHECK-UP



  • Simplify family finances. Consolidate multiple retirement accounts, reducing the need for active management of assets and decreasing the exposure to investment risk as parents age. Consider automatic products that provide regular monthly income and bill payment via electronic accounts.

  • Estimate family income. Calculate total monthly income from sources such as retirement savings plans (IRAs, 401(k)s, pensions), Social Security benefits, personal savings and investments. Create a tax-efficient strategy for withdrawing money from various funds to make sure it lasts as long as possible.

  • Review monthly/annual household budget. Separate “needs” from “wants” and adjust the budget accordingly.

    • Minimize high-interest household debt. Check out www.aarp.org/money/credit-loans-debt for helpful articles in managing debt.
    • Plug “leaks” in the budget; cut unnecessary expenditures and unproductive spending habits.
    • Set aside an emergency fund equal to at least three months of living expenses. 
  • Make housing part of the plan. The financial outlay for a house often remains steep because of mortgage debt and increasing maintenance costs for aging homes. Aging in place is desirable, but your parents need to plan ahead for housing transitions.

    • Consider selling if it could provide an opportunity to get expenses in order without touching retirement savings.
    • Sell unnecessary stuff accumulated over the years.
    • Take advantage of eligibility for New York State’s STAR and Enhanced STAR programs to reduce school taxes (www.tax.ny.gov/star/).
  • Re-evaluate insurance policies. With the help of financial advisers, assess your family’s “protection planning”—that is, insurance policies, including life, disability, homeowners, health and long-term care.  Make sure insurance needs are adequate and beneficiaries are updated. For more information about beneficiary designations, visit the National Endowment for Financial Education website, www.nefe.org and search for “beneficiaries.”

  • Focus on health care coverage. Health care costs—both planned and unexpected medical expenses—will likely consume a significant portion of a family’s financial resources during their loved ones’ later years. Have a realistic picture of what health care is likely to cost if your loved ones live 30 or 40 years in retirement.

    • Make sure family members (both older parents and caregivers) are familiar with basic Medicare programs—Parts A and B—Part C (Medicare Advantage, plans administered by private insurance companies)—particularly what expenses the programs will not cover, such as dental and vision care and long-term custodial care. Medicare Part D, prescription drug programs, also vary widely in coverage and costs.
    • Consider supplementing basic Medicare coverage with private Part B Supplemental (Medigap) health insurance plans to reduce the risk of unreimbursed medical costs. (See following sections on “Navigating Medicare” and “Long-Term Care Planning.”

​​​​Here is a repeat of the above "financial resources check-up" in checklist form:







REVIEWING SOCIAL SECURITY BENEFITS



When your family sits down to discuss future caregiving needs, it’s likely that your elderly loved ones will already be collecting Social Security benefits. But it’s still important to know about your parents’ benefits, since Social Security makes up a substantial share of retirement income for many families—and may have a significant impact on their resources for caregiving.

Even after understanding the basics of Social Security, your loved ones might have additional questions over the years. Some examples:

  • Spousal Benefits. The spouse of a person who is eligible or receiving Social Security benefits may be entitled to benefits, even if they’ve never worked. Application can be made at age 62, but the monthly payments will be reduced.
  • Widow Benefits. A disabled widow or widower may apply for benefits at age 50. A widow/widower who remarries after age 60 is entitled to the same benefit as if the remarriage did not take place.
  • Divorcee Benefits. If a person divorced but their marriage lasted at least 10 years, they are eligible to receive spousal benefits based on their ex’s work record. You must be at least 62 and not remarried.
  • Supplemental Security Income (SSI). This program provides financial aid to persons 65 or over and to the blind or disabled of any age who need financial assistance. Income and resource eligibility levels must be met when a claim is filed.

If your parents are still in the process of deciding how to file for Social Security benefits, it might be worthwhile paying a small fee for assistance from a certified financial adviser. Ultimately, the payback for a good strategy could result in tens of thousands of additional dollars in benefits, depending on a person’s longevity.

​​​​Here are a few "social security benefits" resources:







CREATING A ‘WHAT IF’ PLAN



In the event that your loved ones become unable to adequately manage their financial affairs, they should have designated a Power of Attorney (see prior section), as well as a clear plan to continue handling the family finances. Here is a short list of steps for you and your parents to plan together:

  • Store financial documents in a safe, accessible place.
  • Create a list of account information, from utility bills to tax returns. Put copies of statements in a file, or directions where to find them.
  • Organize and update digital documents, including passwords to online accounts.
  • When practical, arrange direct deposits and online bill-paying.

Family caregivers also should be on the alert to protect loved ones against fraud and predatory marketing. Be on the lookout for mailers with disguised sales pitches, frequent phone mail-order purchases, or large bank withdrawals. AARP’s Fraud Watch Network gives tips to avoid scams and fraud, avoid identity theft and give resources to consumers against potential cons. (Visit www.aarp.org/money/scams-fraud/fraud-watch-network.)







ESTATE PLANNING AND FINANCIAL MANAGEMENT



The aim of estate planning is often to protect your loved ones’ financial resources, minimizing taxes and probate court costs while enabling people to influence how their estate will pass to heirs. But asset protection (revocable and irrevocable) trusts also may become a key component of financial planning for caregiving purposes, providing long-term care when your parents need assistance beyond family caregivers.


Unless your family has sufficient private income to pay the cost of your parents’ care when they need substantial daily assistance, you may eventually have to consider a Medicaid program to assist with or cover the cost of long-term care. The rules to qualify for Medicaid benefits are complex, and elder law attorneys can be instrumental in helping families assess legal tools to plan for long-term care, such as irrevocable trusts or pooled income trusts.  Family caregivers often end up being the trustees or legal representatives appointed to oversee these trusts. See more information in under “Long Term Care Planning” section.

​​​​Here is a listing of a few websites to assist you in estate planning and financial management

SUPPORT FOR VETERANS

If your loved one is a military veteran or veteran’s spouse, they may be entitled to a range of benefits through the U.S. Department of Veterans Affairs (www.va.gov).

Your parent may already be receiving some benefits, but if not, start by locating their discharge papers (DD Form 214), one of the key documents used to determine eligibility requirements for most VA benefits.  (The application and approval processes can be lengthy.) Benefits cover a range of services and programs, including medical care, pensions, disability compensation, community-based residential care, treatment programs, burial benefits, and other services to eligible vets and qualifying family members.

The VA also has Caregiver Support Program that offers educational resources, multiple tools and services designed to help family caregivers:

  • Caregiver Support Line (Toll-free 1-855-260-3274)—Provides immediate assistance or emotional support, help access services, or connect you with a local Caregiver Support Coordinator—a licensed professional who can match your family with services providing home health aides, skilled home care, respite care, and hospice.
  • Caregiver Peer Support Mentoring program—Pairs caregivers with volunteer mentors who agree to share experiences and provide support by phone, email or mail for six months or longer.
  • Aid & Attendance—A tax-free pension benefit that can help a veteran or veteran’s spouse meet the costs of an assisted living facility or the costs of care at home.


For more information about the Caregiver Support Program, including assistance for home care or long-term supportive services, visit www.caregiver.va.gov.

​​​​Here are a few resources in support of veterans

NAVIGATING MEDICARE

Dealing with Medicare can be a daunting task—and often, it’s the caregiver who is called upon to coordinate care and complex paperwork. Despite such challenges, several significant improvements are set to go into effect in 2019, and both caregivers and recipients should be sure to stay on top of ongoing changes.

In short, Medicare is a federal health insurance program administered by the Social Security Administration that provides health care for people age 65 and older, people younger than 65 with certain disabilities and people with end-stage renal disease (permanent kidney failure equiring dialysis or transplant).

There are four parts to Medicare:

  • Medicare Part A (hospital insurance)
  • Medicare Part B (medical insurance)
  • Medicare Part C (Medicare Advantage)
  • Medicare Part D (prescription drug coverage).

Parts A and B are called Original Medicare, also known as fee-for-service or traditional Medicare. As an alternative to Parts A and B, Medicare beneficiaries can choose a Medicare Advantage Plan, which offers Medicare-approved managed care health plans run by private companies. Some people get additional health insurance coverage, like Medicare Supplement Insurance (Medigap) to help pay for items not covered by traditional Medicare.


Medicare is steadily broadening the availability of “telehealth” programs that enable patients to confer with a doctor or nurse via telephone or the internet. In 2019 it will begin covering telehealth services for people in end-stage renal disease.

Enrollment: If seniors are 65 and collecting Social Security benefits or Railroad Retirement benefits, they will be automatically enrolled in both Medicare Part A and Part B. But those who are 65 and not receiving either of these benefits will need to actively enroll in Medicare. (They can apply online at www.medicare.gov or through their local Social Security office or Railroad Retirement Board field office.)

For many seniors, the initial enrollment period for Medicare Part A, Part B and Part D is the seven-month window that begins three months before the month they turn 65 and ends three months after the month they turn 65. If people miss that initial window, they may still enroll between January 1 and March 31 of each year, although their coverage won’t begin until July 1.

There are financial consequences for missing the sign-up windows for Medicare—seniors could wind up paying higher premiums. But under certain special conditions, people may be able to sign up outside of regular enrollment periods. For example, for those who continue working past 65 and are covered under a group health plan based on their current employment, there is a Special Enrollment Period to sign up for Part A or Part B—an 8-month span that starts the month after the employment or the group health plan insurance ends.

Here is a more detailed summary of the four programs:

Medicare Part A—Hospital Insurance


Part A helps pay for:

  • inpatient hospital care
  • medically necessary inpatient care in a skilled nursing facility after a hospital stay
  • medically necessary home health care
  • hospice care

Medicare DOES NOT pay for nursing home, long-term or custodial care.


Part A is free, although there are deductibles and co-insurance. Most people pay no monthly premiums, if they are entitled to Social Security or Railroad Retirement benefits.

Recipients must meet certain conditions to qualify for coverage, including a doctor’s certification or prescription. Usually, a certified home health care agency coordinates any home care services ordered by a patient’s doctor. Patients and caregivers should consult with their doctor to make sure Medicare covers a prescribed service or supply. In addition, they can log onto Medicare.gov and click What Medicare Covers.

Medicare Part B—Medical Insurance

Part B is optional to people who qualify for Part A. It can help pay for:

  • services (lab tests, surgeries, and doctor visits) considered medically necessary to treat a disease or condition.
  • outpatient medical care, such as doctor visits and physical therapy
  • ambulance services
  • durable medical equipment (such as walkers and hospital beds) and a number of other health services and supplies not covered by Part A
  • limited number of prescription drugs

Part B also covers a roster of preventive and screening services, including tests for serious illnesses and chronic conditions such as diabetes, heart disease and cancer. It also covers two types of routine preventive doctor visits: one when you’re new to Medicare and one each year after that. (Visit www.medicare.gov, Click What Medicare Covers, then Preventive and Screening Services.)

Most doctors accept Medicare patients, but some don’t, so be aware that if a physician has opted out of Medicare, the patient is responsible for the bill. Also, it’s important to find out whether a doctor accepts Medicare “assignment”—that is, that he or she has agreed to the Medicare-approved amount as payment in full—or whether the doctor can charge the patient up to 15 percent above this amount.

Part B recipients pay an annual premium each month, which deducted from their Social Security check. Most people will pay the standard premium amount, although higher-income individuals may pay an extra charge. There is also a Part B yearly deductible before Medicare picks up its share, which is typically 80 % of the Medicare-approved amount of the service.

In most cases, people who don’t sign up for Part B when they’re first eligible have to pay a late enrollment penalty.  The monthly premium for Part B may go up 10% for each full 12-month period that they could have had Part B but didn’t sign up for it.

Medicare Part C—Medicare Advantage


Medicare Advantage (MA) Plans are Medicare-approved health plans administered by private insurance companies that generally cover all health care provided in Part A and Part B coverage. They often offer additional benefits, such as vision and dental coverage, and many provide prescription drug coverage. MA plans include Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), which usually require enrollees to get care from providers in the plan’s network or pay more for those outside the network.


Enrollment: Seniors can apply for Medicare Advantage plans during in the same seven-month period as their initial Part A and Part B eligibility, beginning three months before they turn 65 and ending three months after the month they turn 65.  There is also an Annual Enrollment Period from October 15 to December 7 every fall, when Medicare beneficiaries may join, switch or drop a Medicare Advantage plan. (Coverage for enrollment changes takes effect on January 1.) In addition, between January 1 and February 14, enrollees in a Medicare Advantage plan can leave the plan and switch to Original Medicare.

A listing that compares basic costs for dozens of Medicare Advantage plans in the New York metro area is available in the “Medicare & You” handbook. On the www.medicare.gov website users also can search for Medicaid Advantage plans by ZIP code. (Click “Find Health & Drug Plans.”)

Medicare Part D—Prescription drug insurance


If seniors choose a traditional Medicare plan, they also can arrange for separate prescription drug coverage, administered by a roster of private companies approved by Medicare. These plans help cover the cost of prescription drugs and vary widely in terms of monthly premiums, copayments and deductibles. Seniors enrolled in a Medicare Advantage plan that includes drug coverage don’t need Part D.

Part D is optional, but if your loved ones decide not to enroll in a plan when they are first eligible—the seven-month initial enrollment period for Medicare—they may pay a penalty if they join one later. (As with Parts A and B, if seniors are currently covered by an employer or union plan they can enroll later without penalty.)

When shopping for a Medicare D plan that meets their needs, families can use the Plan Finder, the online tool on www.medicare.gov (Click “Find Health & Drug Plans”). Plug in the senior’s Medicare number and drugs (each drug’s name and dosage); the tool then displays a list of available plans, their estimated cost, premium, and deductibles; and which drugs are covered.


Medicare Supplemental Insurance (Medigap)


Medigap plans are offered by private insurance companies to help supplement deductible and co-payments for services provided by traditional Medicare. They do not pay for services unless these services are partially covered under Medicare Part A or B. Federal and state regulations have established minimum standards for companies offering Medigap policies, identified in most states by letters A through D, F through G, and K through N. Plans can vary widely, so families should compare options carefully.

To find companies that offer Medigap policies on Long Island and compare plans, visit www.medicare.gov, then click Supplements & Other Insurance.  You can also click on the Publications tab to download the booklet, Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.

Helpful resources to help you navigate Medicare:

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