Chapter l:

Preparing a Plan

Chapter I:    Preparing a Plan

To care for those who once cared for us is one of the highest honors.

—Peggi Speers and Tia Walker, The Inspired Caregiver:

Finding Joy While Caring for Those You Love

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 tough conversations.  They cover complex subjects, ranging from financial and health issues to estate planning issues—sensitive topics that loved ones may be reluctant to discuss with other family members.  And they’re emotional issues, often resulting in an uncomfortable reversal of adult-child relationships. We’re forced to acknowledge that while we’d all like to see our family members or friends as robust and independent persons forever, the odds are they will need our care at some point. Even if they don’t want it.

Too often, families and couples avoid such conversations until a crisis arises—a fall, an accident, or a serious health diagnosis.  We allow ourselves to succumb to a condition I call (somewhat tongue-in-cheek) PDD—“Planning Deficit Disorder.”

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 loved ones are healthy, sharing information and weighing options and preferences before a crisis happens.

So how do you start?  As I discovered, you start with yourself.

As you read this guide, reflect on your own life’s plans and expectations.  Discuss them with your spouse or significant other.  While reviewing plans for your loved ones, make sure you have your own critical documents, such as a will, health care proxy, and power of attorney.  Take notes about your own needs and fill out the checklists in this guide for yourself, as well as your loved ones, and you will discover the true continuum of caregiving across generations.

Setting the Scene—In Person or Online

Everyone’s situation is different.

You and your family members could decide to bring up these topics informally or in a formal, planned meeting, whichever seems appropriate. While these sensitive conversations certainly benefit from face-to-face interaction, many families may continue to worry about health and safety issues, even as the pandemic has subsided. At the same time, we now have opportunities for virtual meetings that most of us rarely experienced before. The explosion in popular online platforms like Zoom, Skype, Free Teleconferencing, Facebook Live, WhatsApp, Microsoft Teams, and Google Hangouts has made it easier to bring together family members who live far from each other.

  • Set aside time during holiday visits or other traditional family occasions.  When your family gets together for the holidays remember that your first priority is to celebrate these special times together. Holiday gatherings can be stressful, so don’t bring up emotional topics like long-term planning at the traditional family meal or other events. After these occasions, look for opportunities to have relaxed, unrushed conversations, say at breakfast after the big family dinner. But don’t take this discussion lightly; plan in advance to have more than one conversation over the course of several hours. Perhaps start by mentioning someone else’s situation—someone the family knows who may be having health problems or even some aging celebrity in the news.  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 raise 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 a way of ensuring that your loved ones get help when they need it—in ways they want to be helped.  Ask them, “Can we look at this together?” Reassure them that having the conversation does not mean that changes are imminent or inevitable.
  • Frame the conversation in a supportive way, reminding your loved ones that this is about their wishes.  Like many older people, 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 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.
  • Show them this Caregiving Navigator. Tell them you’re learning a lot from it and you would like to share your thoughts with them.
  • Consider enlisting the help of a trusted outsider, like a financial advisor, doctor or clergyperson. Your loved ones may feel more comfortable broaching these topics with them, rather than younger adult family members.  That’s OK— you just want to begin the conversation with someone your loved ones will listen to, creating a bridge to the next generation.
  • Keep in mind your loved ones’ ethnic and cultural traditions.  Your family may have long-held (or unspoken) expectations about how elders should live during their later years—and how adult children, spouses or other relatives should be involved in their caregiving.

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.

Tips for Having the First Conversation

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

  • Let your loved ones 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 loved ones’ 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 loved ones have had a chance to express their thoughts, you and other family members share your views.  Be honest about your own concerns. Are you worried that your loved ones aren’t safe? That they don’t have enough access to friends and social activities?  If your loved one is caring for a spouse or partner, are the duties too much?  And if your loved ones assume that their adult children will be the “default plan” when it comes to caregiving duties, what impact will that responsibility have on the caregivers’ jobs, children, and other responsibilities?

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

Think of this process as the beginning of a series of conversations, integrating legal, financial, and caregiving needs as they unfold over time. I like the approach offered by one of my professional colleagues, Brian Tully, an experienced elder care law attorney: He calls it Life Care Planning.  Putting together “documents and dollars” are not enough, Brian points out. Caregivers and their loved ones “want peace of mind, stability, dignity, quality of life, and the tools to manage change and the coming transitions.”

All in the Family: The Sibling Syndrome


If you and your siblings are taking care of a parent or another elderly loved one, you’re lucky if you agree on a caregiving plan. But that’s often not the case. When siblings don’t share the same priorities, it can flare up into a war, and in some cases, sadly, they end up never speaking to each other again once your loved ones are gone.

To help families avoid such situations, caregivers and care recipients 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. You and your siblings are affected by how each of you related as family members growing up, yet those past roles should not continue to define you today—especially in the context of current 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 family member frequently ends up as the primary caregiver. This role should not necessarily default to the person who lives closest but delegated to the one who is most skilled, willing, and emotionally prepared. In some cases, the primary caregiver may end up moving in with an elderly loved one, which could provide additional support and financial savings for both generations. In other instances, the care recipient may move into one of his or her caregivers’ homes. Whatever the plan, the primary caregiver should make a list of tasks that need to be done. Share them with their siblings and talk about where the primary caregiver needs help and what each of them could reasonably do to share the overall burden.  Be specific about how each person can contribute—perhaps with respite care, assistance in navigating entitlement benefits, or managing financial assets and estate planning.

In my family, for example, three of us lived close to Mom, but our fourth brother lived far away, so he could not practically participate in our mother’s daily care. But he was a skilled physician, and we regularly teleconferenced him into family meetings, where his broad medical knowledge was especially valuable in assessing Mom’s changing health conditions.

Good communication is critical. The primary caregiver needs to:

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

Conversely, family members also should consider what must be done to support the primary caregiver as they carry out these often-demanding, emotional and time-consuming responsibilities. As I noted in Chapter VI of the Navigator, “Caring for Yourself, the Caregiver”, if caregivers themselves are not cared for, they can’t take good care of their loved ones. What can families do to make sure that caregivers stay healthy and avoid burnout?  

And finally, there is the sensitive topic of money: If the care recipients are parents who decided to provide some financial compensation or transfer assets such as their house to the primary caregiver in return for their substantial support, it’s critical that these agreements be spelled out in writing—and explained to other members of the family to avoid any surprises.

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 Your Plan: Don’t Worry, it’s Just a Draft

There is no one “right” caregiving plan, but 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 loved ones’ goals, 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 community resources. Remember, effective caregiving often requires “care-partnering,” sharing responsibilities with financial and legal professionals, government and social service agencies, and health care providers.
  • Set up a communications system that keeps everyone in the loop. AAnd 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 loved ones’ 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, social workers, elder law attorneys, geriatric care managers and financial advisers—all these professionals can help family members get on the same page. Some experts, such as social workers, usually provide support at no cost; others may charge for their services, but it is usually money well spent, an investment in the well-being of the entire family.
  • Consider this the first of many conversations.  There may be many complex, evolving issues you’ll have to balance, such as weighing the best health care options along with the best overall support system for your loved ones. Discuss what matters to both care recipients and their caregivers; be open to compromise.

Even if the conversation does not go smoothly, you will have accomplished something: The seed has been planted. Your loved ones 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.

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.

Here are some helpful resources to jump-start these early family conversations:

Helpful resources to jump-start the conversations:

The Family Meeting Checklist

My brothers and I didn’t really start employing the family meeting process in earnest until after our father died suddenly of a heart attack, at age 76. Our Mom was close to ten years younger, seemingly in good health and capable of driving, writing, reading, cooking, and caring for herself.  So our initial family meeting focus was on regularly talking with her to make sure she was in good shape financially—such as helping decipher her husband’s life insurance policies—and encouraging her network of family, neighbors and friends to stay in touch while she lived alone.

One of our first decisions in evaluating Mom’s health care was to switch her primary medical care to a “concierge practice,” a private medical network that we believed would provide more personalized, in-depth care and availability for a set annual retainer.  We wanted to make sure Mom was guaranteed at least quarterly exams with physicians who were nearby and weren’t overwhelmed with a plethora of patients. These were generally in-office appointments but could have involved home visitation as well, if necessary.

We soon realized, however, that as Mom’s situation changed with age, so would our family meetings. Yours will, too.

Here is a short list of suggested topics to help keep your early meetings focused. Whether you’re a planning to care for a spouse, a parent, another relative or friend, here is a list of things to consider. Yes, the list is short, but the topics can be formidable.

Here is a short list of topics to help you focus on the plan:

Caregiving Resources

There are dozens of national nonprofit organizations, caregiving advocates, and government agencies that offer websites with useful caregiving resources, information, and advice. Researching them can be overwhelming, but if you have siblings or partners willing to help, you might divvy up portions of the following lists and then share your findings. 

Here is a listing of some general caregiving resources:

Note: clicking this symbol

in the menu above will give you quick access to all resources from any page in the website

ELDER CARE SPECIALISTS

As the U.S. population has gotten older, the field of specialized experts and advisers who serve the needs of older people has also grown.  Before you meet with one of these professionals, do some homework. Find out what kinds of services they provide and be clear about what specific needs and tasks you’re looking to address.

Certified Senior Advisors

Professionals who are Certified Senior Advisors offer multidisciplinary services to older adults. The CSA credential is given by the Society of Certified Senior Advisors, which requires individuals to pass a comprehensive exam covering areas such as health and mental health, financial literacy, family and social issues, Medicare, Medicaid, and Social Security. CSAs also must pass criminal background checks and agree to uphold the organization’s code of professional responsibility. The CSA website includes a locator to find advisors in your geographical area.
 

Here is a sampling of other types of senior specialists and experts:

There are also a number of professional organizations with local chapters on Long Island whose members can be valuable resources for caregivers and their loved ones.

Here is a listing of some elder care specialists:

Here is a listing of some local government agencies:

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 reviewing wills creating trusts, and designing estate plans to preserve assets.

If family caregivers are adult children, they should be aware that when parents hire an elder law attorney, the attorney represents the interests of the parents —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, I started with referrals from people I trusted, including some close friends whose situation was similar to mine, as well as business colleagues, my financial advisers, and health care professionals. Then I widened my search by comparing my referrals with listings and information services in local and national legal organizations.

Of course, the internet has become a standard starting point for finding basic information about elder law attorneys and their practices. Many attorneys are offering free webinars and email newsletters covering eldercare issues that have taken on growing currency as many more people are living longer and need an array of services as they age. Topics range from long-term care planning to changes in Medicaid regulations for home care; the creation of advance directives like health care proxies and powers of attorney; trusts and estate planning, and how to conduct difficult family conversations, like funeral arrangements.

Many elder law attorneys also are partnering with financial advisors, social workers, patient advocates, and assisted living communities in presenting joint events. Regularly check the events calendar at your local public library or senior center for these presentations.

Consider elder attorneys who are members of national organizations that specialize in providing legal services to older individuals and their families, such as:

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

What to Ask When You’re Hiring an 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, which should be free. Confirm their background, experience and credentials:

  • How long has the attorney been in practice?
  • Is the attorney a member of the National Elder Law Foundation or 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 non-profit groups such as a local Alzheimer’s organization 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 an asset for seniors and their caregivers, helping to explain complex regulations, and identify unforeseen alternatives as well as potential family conflicts—before they become crises.

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 loved ones should have a conversation with their family caregivers 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. Your loved ones also should consider keeping a copy of their health care proxy in their wallet, in case of a medical emergency.

Both family caregivers and their loved ones should review these directives every few years, since changes in state law, as well as changes in personal situations can affect how the provisions of legal documents are carried out.

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 notarized, but the form must be signed in the presence of two adult witnesses, not including the agent.

In fact, everyone over age 18—including young adults who are college students—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 decisions according to 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.

You don’t need to hire an attorney to complete a health care proxy. To obtain a sample form go to the New York State Department of Health website (www.health.ny.gov) 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, PO Box 2000, Albany, NY  12220.

Living Will


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

My Mom, for example, openly dictated her end-of-life-care wishes to all four sons.  After observing the fates of many of her older friends and neighbors, she repeatedly asked us to promise that we would never put her in a nursing home—she wanted to die in her own home.

Yet Mom also believed there should be limits to efforts to keep her alive, even at home. She visited a neighbor who lived for more than 10 years with a feeding tube pegged to her stomach.  So, she stipulated that if she lost mental capacity AND she could not be fed or was able to swallow, she did not want any heroic, life-saving measures performed.

If a person does not have a health care agent, a living will is better than having no advance directive at all.  Still, no statute in New York 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. And both

A sample living will form is available on the New York State Bar Association website (https://nysba.org/WorkArea/DownloadAsset.aspx?id=21705)

 In addition, if your loved one already has serious health conditions, they should consider completing another critical document, known as a MOLST, which stands for Medical Orders for Life-Sustaining Treatment.  These medical orders, including instructions regarding “Do Not Resuscitate Orders” or “Do Not Intubate Orders,” are intended to document to health care providers a person’s wishes and preferences in providing medical care at the end of life. (See more information in Part V of the Navigator)  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”).

FINANCIAL AND ESTATE PLANNING

Powers of Attorney (Modified)


The  Power of Attorney gives an “agent” broad powers to take care of certain business or financial matters on behalf of another person, known as the “principal.” While such documents are often created in case older loved ones are no longer able to make decisions on their own, a principal does not need to become incapacitated for the power of attorney to be triggered. Agents must act according to the instructions of the principals, or where there are no instructions, in their best interest.

In New York State the principal must sign a power of attorney in the presence of a notary and two witnesses (the notary can be one witness); it does not become effective until it is signed by the agent. That authority ceases upon the death of the principal or revocation of the power.

If a POA was completed several years ago it’s especially important that families review changes to POA provisions that went into effect in 2021. Under the new POA law, a separate document known as the  “Statutory Gift Rider” (SGR), has been eliminated. Previously, if a principal wished to authorize their agent to make gifts of the principal’s money or any other property, they were required to separately execute an SGR. Under the new law, principals may now modify a standard POA to authorize themselves to make gifts up to $5,000 (increased from the previous limit of $500) in any one year, or to make other changes to interests in their property without the need for an SGR. Plus, any gift in excess of the $5,000 limit can be made by stipulating that authority in an optional modifications section in the POA form itself.

The new statute also greatly expands an agent’s permissible authority over the principal’s health care matters, although that authority extends only to financial issues. It does not permit the agent to make health care decisions for the principal; such decisions still require a health care proxy.

There are four basic types of powers of attorney:

A general power of attorney enables an agent to perform almost any act as the principal, such as opening financial accounts and managing personal finances. A general power of attorney arrangement is terminated when the principal becomes incapacitated, revokes the power of attorney, or dies.

A durable power of attorney may be used immediately and remains in effect until the principal revokes it or dies.  It includes a durable clause that maintains the power of attorney after the principal becomes incapacitated–mentally incompetent or physically unable to make decisions.

A nondurable or limited 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 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.

Many online resources like the New York Bar Association offer to consider when drafting a power of attorney (https://www.nyc.gov/assets/hra/downloads/pdf/services/homelessness-prevention/poa.pdf).  But a POA should be executed with the guidance of an elder law attorney to ensure that areas of authority are clearly defined and understood by both loved ones and their family members.

Last Will & Testament


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.

ASSEMBLING VITAL DOCUMENTS

In addition to making sure that your loved ones have their key legal documents in place, families need to assemble key information relating to various aspects of their personal lives. It can be a big job, so try breaking this process into manageable steps:

1. Identify where your loved ones keep their important papers. Make sure they’re in a safe place, whether at home, in a fireproof file cabinet or safe, 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, or they’re in a safety deposit box where no one else in the family has the keys.

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 as 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 fireproof safe.

4.  Make sure you know who is authorized to speak to company or government agency representatives if 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, or whenever there is a major life change.

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. (More than a few years after my Mom died, we still have not digitized many photos from family albums. But we did convert dozens of 8 mm films several years ago, and that gave us many hours of joyful reminiscing with her.)

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. And in case of an emergency, identify who needs to know about your loved ones, and what they need to know.

Here is a suggested list of vital documents and information

ESTATE PLANNING

The primary aim of estate planning is to protect your loved ones’ financial resources, minimizing inheritance taxes while enabling them to control how their estate will pass to heirs or charitable causes.

Estate planning also is an important way to avoid the additional stress of a court proceeding known as probate, which is required when a person passes away with assets solely owned by them. Probate proceedings often result in significant delays in settling an estate, court costs, legal fees, and public exposure of a loved one’s estate. At a time of growing identity theft and fraud, especially among seniors, it’s advisable to maintain the privacy of your family members and the assets being inherited.

There are three basic ways to avoid probate. First, if a loved one’s assets are owned jointly with another person, they will automatically pass to that person upon the death of the first owner. Second, if assets are placed in accounts such as IRAs, annuities, or life insurance policies that have beneficiaries, the assets will transfer directly to those beneficiaries, once a claim form is completed. Third, if a person’s assets are placed in a revocable or irrevocable trust, probate can be avoided for the assets held within those trusts.

In addition, asset protection through a trust may become a key component for caregiving purposes, providing legal structures for 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. While getting Medicaid coverage can result in huge financial savings, the rules to qualify for such benefits are complex, and elder law attorneys can be instrumental in helping families implement legal tools to plan for long-term care, such as irrevocable trusts or pooled income trusts. 

As was the case in my family, the adult children often end up being the trustees or legal representatives appointed to oversee these trusts. (See more information in the “Long-Term Care Planning” section)

THE ‘LONGEVITY RISK’:

ASSESSING YOUR FAMILY’S FINANCIAL SITUATION

Older couples usually have some kind of financial plan for their later years, whether or not they decide to “retire.” Too often, however, it’s not in writing, or limited to a monthly budget of expenses and retirement income and other assets. The bigger issue—the one that keeps many seniors up at night—is what financial experts call the “longevity risk.” That is, as advances in health and medicine enable us to lead longer and healthier lives, the risk that we may end up outliving our retirement savings.

It’s important that you are informed about your loved ones’ financial resources,  because eventually, you may end up being in charge of their money as part of your overall caregiving responsibilities. That’s what happened to me—with no preparation. Our father died unexpectedly of a heart attack and had not shared much information about the family’s assets with Mom, who was a shrewd manager of their monthly budget but not privy to most of Dad’s financial dealings. At the time, Dad was not actively working with a financial adviser or attorney. So, Mom asked me, along with my brothers, to ferret out the insurance, annuities, three stock portfolios and various other assets. It took almost two years to assemble all the records and resources, create a financial/legal team and set a new course for Mom.

Older couples usually have some kind of financial plan for their later years, whether or not they decide to “retire.” Too often, however, it’s not in writing, or limited to a monthly budget of expenses and retirement income and other assets. The bigger issue—the one that keeps many seniors up at night—is what financial experts call the “longevity risk.” That is, as advances in health and medicine enable us to lead longer and healthier lives, the risk that we may end up outliving our retirement savings.

It’s important that you are informed about your loved ones’ financial resources,  because eventually, you may end up being in charge of their money as part of your overall caregiving responsibilities. That’s what happened to me—with no preparation. Our father died unexpectedly of a heart attack and had not shared much information about the family’s assets with Mom, who was a shrewd manager of their monthly budget but not privy to most of Dad’s financial dealings. At the time, Dad was not actively working with a financial adviser or attorney. So, Mom asked me, along with my brothers, to ferret out the insurance, annuities, three stock portfolios and various other assets. It took almost two years to assemble all the records and resources, create a financial/legal team and set a new course for Mom.

Conducting an Annual Financial Checkup

Before a crisis hits, caregivers can help their loved ones conduct a “financial checkup,” especially when it comes to two major areas of concern: housing and health care/long-term care costs.

Housing costs will depend greatly, of course, on your parents’ living preferences in their later years: Do they want to age in place, and for how long? Do they want to move to an independent living complex or a 55-plus retirement community? And eventually, will they prefer to—or need to—move into some type of assisted living community? When my Mom became a widow, she made it abundantly clear to us that she wanted to remain in her home for as long as possible, so that established some financial parameters right away. (For more, see “What’s Your Loved Ones’ ‘Retirementality’?” )

Calculating future health care and long-term care costs can be much trickier. Who knows how long any of us will live, what illnesses or ailments may arise—and how fast health care costs will rise in our later years? According to the recent Fidelity Investments’ Retiree Healthcare Cost Estimate, by the time a person reaches age 65 the average health care costs are $11,300 per year. And the average 65-year-old couple retiring now can expect to spend $315,000 on health care and medical expenses throughout retirement. (The average American couple estimated the total cost of health care in retirement to be only $41,000!) Many people still assume that Medicare will cover all their health care costs in retirement, but it doesn’t. So families need to carefully plan ahead and weigh their options to lower costs, wherever possible. 

Here is a Financial Resources Checklist that could apply to multiple generations:

Finally, visualizing these later years is not unlike planning a vacation—a long one. Your parents (and ultimately you, too) need to pick a destination (how 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.

In many families, a financial checkup should incorporate two checkups: One for your elderly loved ones, and a second for the adult children, who may end up assuming some of the costs of caregiving, on top of other responsibilities. A recent AARP study found that family caregivers can expect to pay an average of more than $7,400 a year for caregiving expenses. The biggest out-of-pocket expenses for caregivers often include contributing to household costs of their loved ones, medical needs, legal fees, caregiving assistance, and travel. One in five caregivers experiences short-and long-term financial strain, so before you undertake the job, it’s important to review your own financial strength.

The first step in assessing your loved ones’ situation is to make sure your loved ones have a financial adviser who is a “fiduciary,” an 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. Advisers who are designated as Certified Financial Planners are professionals who meet the educational and ethical requirements set by the Certified Financial Planner Board of Standards.

These advisers 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 the Certified Financial Planner Board of Standards website (www.letsmakeaplan.org).

Protecting Your Loved Ones Against Financial Fraud

Be prepared to protect your loved ones against fraud and predatory marketing—a growing epidemic, especially targeting seniors who live alone. These scams have taken on a troubling variety of sophisticated tactics: identity theft schemes; lottery and sweepstake scams; and imposter phone scams, such as callers claiming they’re with the IRS, Social Security, or a company’s customer service department; or callers pretending to represent a family member in distress who needs money.

And sadly, people who have been victimized by fraud (I’m one of them!) may be too embarrassed or upset to tell other family members or law enforcement officials. 

Be on the lookout for mailers or emails to your loved ones with disguised sales pitches, frequent phone mail-order purchases, or large bank withdrawals. Also, here are some signs that you or one of your loved ones may have been a victim of identity theft (someone has stolen your “Personally Identifiable Information” or PII):

  • Household bills stop showing up in the mail.
  • A credit or loan application is denied.
  • You get statements for purchases you didn’t make.
  • Fraudulent transactions appear on your financial accounts.
  • A tax return is denied.
  • Small charges appear on your credit card statement.

It's often difficult to recover losses from a scammer, so the best strategy is to prevent fraud in the first place.  Here are a few tips from experts at AARP’s Fraud Watch Network to protect your loved ones.

  • When dealing with phone solicitations:
  • Don’t answer calls you don’t recognize; let them to voicemail. If they’re legitimate, they’ll usually leave a message.
  • Hang up on robocalls (no need to be polite).
  • Never feel pressured to give financial information over the phone.
  • Be wary of false urgency to provide information or make decisions.
  • Do not click links from emails or texts; type the web address you know to be valid into your browser.
  • Review your credit bureau reports regularly.
  • Use a credit card, rather than debit card, to limit financial exposure.
  • Opt for electronic statements (thieves can steal statements from your mailbox).
  • Protect personal information by shredding bank documents, credit card receipts and financial records before throwing them in the trash.
  • If you’re hiring in-home care, properly screen the person with a background check.

Reviewing Social Security Benefits

When your family sits down to discuss future caregiving needs, your elderly loved ones may 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. 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. An application can be made at age 62, but the monthly payments will be reduced. And If your spouse was born before January 2, 1954, and has already reached full retirement age, they can choose to receive only the spouse's benefit and delay receiving their own retirement benefit until a later date.
  • 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 have 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’s often worthwhile to consult with a certified financial adviser or a Social Security expert about different filing options. Many advisers can do a “break-even analysis,” calculating the point when total lifetime benefits would be equal or better by delaying a claim with the amounts generated by claiming earlier.

Ultimately, the payback for picking a certain strategy could result in tens of thousands of additional dollars in benefits, depending on a person’s longevity.

Support for Veterans

If your loved one is a veteran or veteran’s spouse, they may be entitled to a wide range of basic benefits through the U.S. Department of Veterans Affairs, provided they received an honorable discharge from the military.

Your parent may already be receiving some benefits, but if not, start by locating their discharge papers (DD Form 214). If you can’t find their copy of DD214, this website can help: https://themilitarywallet.com/dd-form-214-verification-of-military-service. 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.

While approval time can be lengthy for some benefits, the process to enroll for healthcare benefits can be quick if you have a copy of the DD214 and submit VA form 1010-EZ through the VA’s local medical center Patient Enrollment office. (See Resources below.)  It usually takes only a few days to process, and Patient Enrollment will assign a Veteran a Primary Care Physician (PCP). The PCP or PCP’s social worker is effectively the gateway to healthcare services and home healthcare services.

The VA Standard Benefits Package includes long-term care home and community-based services for older veterans, provided that the vet has a clinical need for it and the service is available in their area. For more information, log on to www.va.gov/geriatrics

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 855-260-3274). Provides immediate assistance or emotional support, help access services, or connects 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. There is also a Crisis Line (800-273-8255) staffed 24/7 by mental health clinicians who can help anyone with a caregiving crisis, including veterans who are taking care of a family member.
  • 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 and 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. (There is a financial threshold for eligibility.) Under the recently passed federal Veterans Mission Act, veterans can get expanded access to private care not previously available through the VA or the Veterans Choice Act. 

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:

Managing Medicare can be a daunting task. While family caregivers may be years away from receiving their own Medicare benefits, it’s important to know how the program works because it’s often the caregivers who are called upon to coordinate care and complete complex paperwork (sometimes more than once!) for their older loved ones. I know from experience. Handling my mother’s Medicare coverage grew more time-consuming and laborious over the years, as we dealt with a growing number of chronic conditions. At the same time, it was also a bracing education for me, an eye-opener as to what I would need to know for myself in the not-too-distant future.

So, what in a nutshell, is Medicare?

It’s a federal health insurance program managed by the Centers for Medicare and Medicaid Services (CMS) that provides health care for people aged 65 and older, people younger than 65 with certain disabilities, and people with end-stage renal disease (permanent kidney failure requiring 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 or Part C Plan. Medicare Advantage Plans are offered by a list of Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). Some people get additional health insurance coverage, like Medicare Supplement Insurance (Medigap), to help pay for items not covered by traditional Medicare.

Here is a more detailed summary of the four Medicare 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 long-term care in nursing homes, or for long-term or custodial care or companion care services in the home. (See “Long-Term Care Planning”.)

 It DOES pay, however, for short-term care in a skilled nursing facility or at home following a care recipient’s discharge from a hospital.

Most people pay no monthly premiums for Medicare Part A if they are entitled to Social Security or Railroad Retirement benefits. There are, however, deductibles and copays, and coinsurance payments for certain services or Medicare-approved medical equipment. (See https://www.medicare.gov/basics/costs/medicare-costs.)

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 short-term 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 https://www.medicare.gov/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 several 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 https://www.medicare.gov/coverage/preventive-screening-services)

Medicare Part B recipients pay an annual premium each month, which is deducted from their Social Security check. Most people will pay the standard premium amount, although higher-income individuals may pay more.

Part B covers only 80 percent of the Medicare-approved cost of medically necessary doctor's visits. There is also a Part B yearly deductible before Medicare picks up its share. (See https://www.medicare.gov/basics/costs/medicare-costs.)

Certain telehealth services are now covered under Part B. These services include office visits, psychotherapy, consultations, and certain other medical or health services that are provided by an eligible provider using an interactive 2-way telecommunications system, like real-time audio and video. For most telehealth services, you'll pay the same amount that you would if you got the services in person. (See https://www.medicare.gov/coverage/telehealth.)

Many 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. Ask ahead of time. Also, it’s important to find out whether a doctor accepts Medicare “assignment”—that is, that they have 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.

Medicare Part C—Medicare Advantage

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

On the www.medicare.gov website users also can search for Medicaid Advantage plans by ZIP code. Medicare rates Medicare Advantage plans for overall performance, using information from member satisfaction surveys, plans, and health care providers to give each plan a rating of between 1 and 5 stars. (A 5-star rating is considered excellent. The average rating in 2023 is 4.15 stars.) These ratings can help families compare plans based on quality and performance.

A print listing that compares costs for dozens of Medicare Advantage plans in the New York metro area is also available in the “Medicare & You” handbook.

Medicare Part D—Prescription Drug Insurance

If seniors choose traditional Medicare, they also should 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, co-payments, 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.) Even if you’re not currently taking any medications, you enroll in Part D—eventually, you will probably need some drug coverage.

When shopping for a Medicare D plan that meets their needs, families can use the Plan Finder, the online tool on www.medicare.gov. 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.

Drug costs can change from plan to plan, pharmacy to pharmacy. Mail orders may also be an option to decrease the cost of medications.

As a result of the recently passed federal Inflation Reduction Act, Medicare recipients will benefit from new regulations designed to help lower the cost of prescription drugs over the next decade. In 2023, the provisions include limiting insulin copays to $35 per month and eliminating cost-sharing for adult vaccines covered under Part D. Other provisions that take effect in subsequent years include eliminating coinsurance above the catastrophic threshold (2024) a $2,000 cap on out-of-pocket Part D spending (2025). And starting in 2026, Medicare will have the authority to negotiate prices for certain high-cost Part D and Part B drugs.

Medicare Supplemental Insurance (Medigap)

Medigap plans are offered by private insurance companies to help supplement deductibles and co-payments for services provided by traditional Medicare, which does not cover 100% of the cost of services. 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 national standards for companies offering Medigap policies, identified in most states by letters A through D; F through G; and K through N. You pay the private insurance company a monthly premium for your Medigap policy, in addition to the monthly Medicare Part B premium.

It’s important to compare Medigap policies since the costs can vary between plans offered by different companies for exactly the same coverage. You can buy a Medigap policy from any insurance company that's licensed in your state to sell one. If you and your spouse both want Medigap coverage, you'll have to buy separate policies. And if you move from one state to another, your plan may remain the same, but you should check to make sure. Some states provide “guaranteed issue”—the same policy with no health questions asked. But in other states you could be rated by age and health status. 

To find companies that offer Medigap policies on Long Island and compare plans, click here, then enter your zip code and click the Start button.

You can also download the booklet, Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.

Enrolling in Medicare

Enrollment in various Medicare plans is full of potential missteps, so be careful in navigating the process. 

  • Initial Enrollment Period (IEP). If seniors are 65 and collecting Social Security benefits or Railroad Retirement benefits, they will be automatically enrolled in both Medicare Part A. 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. A recipient’s coverage starts shortly after enrollment, depending on when they signed up during the Initial Enrollment Period.
  • Medicare Advantage Enrollment.  Seniors can apply for Medicare Advantage plans during the same seven-month period as their initial Part A and Part B eligibility. 
  • Late Enrollment Penalties. Generally, people who don’t sign up for Part B or Part D 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. The cost of the late enrollment penalty for Part D is calculated by CMS, depending on how long you went without Part D or without “creditable” prescription coverage, such as an employer plan. A late enrollment penalty is assessed monthly for as long as you’re enrolled in Medicare, so if you’re not sure whether you have to pay, contact the agency directly to find out.
  • Special Enrollment Periods. Under certain circumstances, those who do not sign up during regular enrollment periods may not be subject to a late penalty fee. For example, those who continue working past 65 and are covered under a group health plan covering 20 or more employees can use a Special Enrollment Period to sign up for Part B—an 8-month span that starts the month after the employment or the group health plan insurance ends.In addition, as a result of federal legislation passed in 2021, five new Special Enrollment Periods were created, including periods for individuals affected by an emergency or disaster or those affected by a health plan or employer error.
  • Annual Enrollment Period. After you sign up for Medicare,  there is also an Annual Enrollment Period (AEP) from Oct. 15 to Dec. 7 each year that allows Medicare recipients to review their current Medicare coverage and make changes in their plan, such as switching from Original Medicare to a Medicare Advantage plan, changing from one Medicare Advantage plan to another, or dropping a Medicare Advantage plan and going back to Original Medicare. A person can change multiple times, with the last plan selection taking effect on January 1.
  • Open Enrollment Period. Between Jan.1 and March 31, there is a period when people already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or switch to Original Medicare and enroll in a Part D plan. Only one plan change is allowed during this window.
  • Medigap Open Enrollment. Under federal law, you have a six-month open enrollment period for Medigap or Medicare Supplement Insurance that begins the month you are 65 or older and are enrolled in Medicare Part B. It generally makes sense to enroll during this period because Medigap companies must sell you a policy at the best available rate regardless of your health status, and they cannot deny you coverage. After the open enrollment period, you may not be able to buy a Medigap policy or you may pay more due to past or present health problems.
  • After buying your first Medigap policy, you don't have to wait a certain length of time before you can switch to a different policy.

Keeping Up with Medicare Services 

In September every year, all Medicare households are sent a print copy of the  “Medicare & You” handbook, which is the official guide to Medicare. An electronic copy of the handbook also can be accessed or downloaded at www.medicare.gov/medicare-and-you.  The handbook is available in many different formats and languages, including braille.

Still, recipients need to stay on top of their Medicare plans on a regular basis because regulations and options for coverage can change. Not only do annual deductible amounts and premiums vary, but over the last few years there have been some significant policy changes due to new federal legislation—in particular, enrollment regulations and Part D prescription drug coverage. Also, some regulatory flexibilities and waivers that were instituted to allow access to care during the COVID-19 public health emergency will expire in 2023.

The federal government’s official Centers for Medicare & Medicaid Services (CMS) website (www.medicare.gov) not only provides lots of information about each program but also has helpful tips about how to navigate the agency’s services. For example:

  • You can search for Part D, Medigap policies and Medicare Advantage plans in your geographic area.
  • You can find and compare health care providers in your area.
  • You can find a good basic summary of Medicare costs. (https://www.medicare.gov/basics/costs/medicare-costs)

Medicare recipients can create their own personal account in MyMedicare.gov, (https://www.medicare.gov/my/home) a secure site designed to help beneficiaries check the status of their eligibility, enrollment, and other Medicare benefits. It also lets people access their claims information almost immediately after it’s processed and provides beneficiaries with preventive health information daily.

Medicare also offers What’s Covered,” a free app that lets people with Original Medicare, caregivers, and others use their mobile devices to check whether Medicare covers a specific medical item or service. The app is available in both Google Play and the Apple App Store. And every fall, CMS sends all Medicare recipients a print handbook, “Medicare & You,” You can download the handbook from the website.

Consumers can call 800-MEDICARE (633-4227) to get the most current information. And you can sign up for email alerts to get important reminders & information about Medicare.

Medicare Assistance for Families With Limited Incomes

EPIC: The New York State Health Department administers the Elderly Pharmaceutical Insurance Coverage Program (EPIC), which provides seniors with co-payments for Part D-covered prescription drugs after any Part D deductible is met. It also covers many drugs excluded from Part D.  New York State residents 65 or older must be enrolled or eligible to be enrolled in a Medicare Part D drug plan to receive EPIC benefits and can apply for EPIC at any time of the year.  Annual income for eligibility is up to $75,000 for singles and up to $100,000 for married couples. EPIC offers two plans:

The Fee Plan is for members who pay an annual fee ranging from $8 to $300, based on their previous year’s income. EPIC pays the Part D monthly drug plan premiums up to the average cost of a basic Medicare drug plan. Members pay EPIC co-payments for Part D and EPIC-covered drugs after the Part D deductible, if any, is met.

The Deductible Plan is for members who must meet an annual out-of-pocket deductible based on their prior year's income before paying EPIC co-payments for drugs. EPIC also pays the Medicare Part D drug plan monthly premiums up to the amount of an average Part D plan, for members with an annual income of up to $23,000 if single or $29,000 if married. Higher-income members are required to pay the Part D premiums, but EPIC provides premium assistance by lowering their EPIC deductible. For more information, visit https://www.health.ny.gov/health_care/epic/  or call 800-332-3742.

Affordable Care Act: Under the federal Affordable Care Act, the Extra Help program pays prescription drug costs for Medicare recipients with limited income and resources.   For information or to apply online, Medicare beneficiaries or caregivers can visit www.socialsecurity.gov/prescriptionhelp  or call Social Security at 1-800-772-1213.  For additional information, click here: www.medicare.gov/basics/help.

Medicare Savings Program

Medicare Savings Programs are government programs that help Medicare beneficiaries who have limited income and assets but do not qualify for Medicaid. The programs, also known as Medicare Buy-In, aid people with low incomes. There are four kinds of Medicare Savings Programs, and depending on income and assets, qualifying individuals can have a portion of their Medicare expenses paid, including monthly premiums, deductibles, and co-insurance.

In Nassau County:  Contact the Department of Social Services for information and an application (516-227-8000).

In Suffolk County: Call the Office for the Aging (631-853-8200) or the Department of Social Services. (631-853-8730)

Medicare Counselors & Advisers

Every family has its unique health and financial needs, so there’s no such thing as a “one size fits all” Medicare plan. Comparing Medicare and Medicare Advantage plans can be a complicated task, even after reviewing resources and information provided by Medicare. Here are some private professionals, government, and nonprofit resources that can help families cut through the confusion and choose the best plan for them.

Certified Independent Medicare Agents

Independent Certified Medicare agents are insurance representatives who compare different Medicare plans to come up with the best options for individuals based on their situation. Independent agents often represent various companies. They must be licensed by the state insurance department where a plan is sold,

Agents do not sell Original Medicare. They sell Medicare plans sold through private insurers, including Medicare Advantage, Medigap, and Medicare Part D drug plans. Agents work on a commission based on the Medicare policies they sell. Certified Independent Agents must be licensed by the state insurance department where a plan is sold and certified by the insurance carriers they’re representing.

Agents work as an intermediary between you and insurance companies. An agent reviews and researches several different Medicare plan options and then recommends the best plan based on a person’s health needs and the plan’s price. The agent is not allowed to accept compensation from their clients.

“There are so many things to consider,” says Jane O’Malley, an independent health representative on Long Island specializing in Medicare. It’s a very individualized process with clients. “The whole conversation is about where their needs are and how they are going to pay for it,” she says. “They’re looking to me for help and advice. I offer them the options, but they make the decisions.”

Agents may help people assess factors such as the doctors, specialists and medical treatments they use—and whether they’re in a plan’s network—or which drug formularies offer the medications they need.

Agents also may be helpful in alerting Medicare recipients about policies or provisions that they might overlook in choosing or reviewing their plans. For instance, “if you move out of a ZIP code, you may need to change your plan,” notes Marc Samuels, another Certified Medicare Agent. “If you are a snowbird, make sure you have a network of doctors and hospitals in both locations—do not assume so.”


HIICAP

New York State’s Health Insurance Information, Counseling and Assistance Program (HIICAP) is part of the federally funded State Health Insurance Program (SHIP), which offers more personalized counseling for seniors and their families. Trained volunteers can provide information, free counseling and assistance on a whole range of health insurance programs, including traditional Medicare, Medicare Advantage and Medicare Part D, and Supplemental coverage.

Administered by the county aging offices, HIICAP programs are provided through local nonprofits:

Nassau County (Family and Children’s Association):  Call 516-485-3754


Suffolk County (RSVP): Call 631- 979-9490 ext. 18 or Suffolk/NY Connects (631- 853-8200).

Medicare Rights Center

www.medicarerights.org

1-800-333-4114

The Medicare Rights Center, an independent, nonprofit consumer organization, is another useful resource for seniors and caregivers nationwide. The center offers free telephone counseling, provides information, answers questions about coverage, and assists individuals having problems accessing services.

AARP

www.aarp.org

AARP’s website also offers numerous articles that can help caregivers navigate through various issues. Search for “Medicare Basics.”

LONG-TERM CARE

         HOW TO PLAN (AND PAY) FOR IT 

Most older people say they want to live independently for as long as possible.

My Mom did, too. She made it clear to her sons that she wanted to stay in her home— her “terrestrial paradise” that she and Dad built in the early 1950s—until the end.

It’s emotionally difficult for many parents or couples, as well as their adult children, to acknowledge that we all should plan for long-term care in our elder years. Eventually, about two-thirds of those aged 65 and older can expect to need some form of long-term care, through either family or outside services, or both, according to health care experts. So as Mom got older and frailer, my brothers and I knew that we needed to do some long-term care planning, starting with our elder care attorney.

Generally, long-term care covers custodial, rather than medical care—that is, assistance with basic tasks of everyday life, referred to as the six Activities of Daily Living, or ADLs: eating, bathing, dressing, transferring (getting in and out of a bed or chair), toileting, and continence.  Other common long-term care services aid with everyday tasks known as Instrumental Activities of Daily Living, or IADLs, including managing personal finances; taking care of household tasks; shopping for groceries; using the telephone or other communication devices; and caring for pets.

Your initial family conversations about long-term care probably won’t go into detail about specific options for long-term care, such as home care, assisted living, adult day services, or a skilled nursing facility. It may be too early for these discussions. At the same time, your family should be aware that long-term care services can be dauntingly high. According to the Genworth Cost of Care Survey, the median cost of a home health aide nationwide is $61,776 a year, assuming 44 hours of care per week, while the median yearly cost for an assisted living community is $54,000 a year, and the median annual cost for a nursing home private room is about $108,445. The Cost of Care Survey also breaks down these figures into hourly, daily, and monthly costs, as well as by region.

Costs on Long Island, however, are generally much higher than the median figure listed in the survey, according to most local long-term care experts.

Medicare will not pay most long-term care costs. Medicare does help pay for part-time, intermittent home health care aides and support services to those who need intermediate and skilled medical care, often after a hospital or short-term rehab stay. Medicare also will help pay for a short stay in a skilled nursing facility. But it will not pay for most companion or custodial care inside the home or in an outside facility. In addition, private health insurance plans typically do not pay for ongoing long-term care either, although some may provide temporary nursing home coverage.

While your ultimate goal is to provide the best possible care for your loved ones, cost inevitably becomes a critical factor—and without adequate planning, your family could deplete its entire retirement savings within a couple of years. Some options, such as long-term care coverage through Medicaid, have complicated application procedures that require substantial planning to avoid penalties. Other options, like long-term care insurance,  get more expensive and often more difficult to qualify for as you age.

 “Dealing with long-term care is something that should be done in advance, proactively,” says elder law attorney Brian Tully. “You always want to avoid a crisis. When there’s a crisis, you have fewer options and more stress. And more expenses.” So it’s a good idea to do at least some basic planning about how your family might pay for long-term care down the road. For most families, this means just three realistic options:
  • Private pay from family income and assets
  • Long-term care insurance
  • Medicaid or VA coverage

Here are some resources to help caregivers and care recipients assess long-term care options:

PRIVATE PAY

  • Downsizing your loved ones’ home could free up some assets to bring in paid aides or housekeepers.
  • Selling your parents’ current single-family home could provide the funds to cover the cost of long-term care in an adult care community.
  • Investing in a long-term care annuity could provide a specified amount of income paid to you at set intervals, with special provisions to help pay for long-term care.
  • Selling your loved one’s life insurance policy could provide a long-term care life settlement, with the proceeds from the sale used to fund long-term care expenses.

Reverse Mortgages

Another private pay option is a reverse mortgage—a useful tool to help cash-strapped homeowners pay for monthly expenses, including long-term care.

Homeowners 62 and older who have a significant amount of equity built up in their house can use a reverse mortgage to borrow against that equity, taking the cash in a lump sum, as a monthly income stream or a line of credit. The money doesn’t have to be repaid until the owner moves, sells the house, or dies.

Most reverse mortgages today are known as Home Equity Conversion Mortgages, or HCEMs, offered by a program run by the U.S. Department of Housing and Urban Development. Unlike a traditional mortgage, there are no income or credit requirements for reverse mortgages. But HUD has tightened lending criteria, requiring that lenders determine whether would-be borrowers have enough income to keep up with property taxes and homeowners’ insurance.

These loans can be complicated, with substantial fees and interest charges. Before completing the loan process, a borrower must meet with an independent, HUD-approved counselor whose job is to review the transaction.

There are numerous resources to find out more about reverse mortgages, including:

Long-term care (LTC) insurance is private insurance designed to pay for services not covered by Medicare, Medicaid or other health insurance. It’s an important option for many families for several reasons.

“Long-term care is the largest unfunded health risk as people get older,” says Rona Loshak, co-founding partner of Karp Loshak LTC Insurance Solutions, an independent broker specializing in long-term care insurance.

While some families may prefer to fund their long-term care needs through retirement savings, such care often lasts longer and is more expensive than most people realize. Even if you saved money for over 20 years, it probably would not be enough to cover long-term care needs, which will cost an estimated $1.2 million per person 30 years from now, adds Natalie Karp, also a co-founding partner of Karp Loshak LTC Insurance Solutions. The goal of LTC insurance, she says, is to shift the risk, repositioning your savings into a tax-free source of money for likely care in the future.

Long-term care insurance also has become an important option for a growing number of seniors who are aging alone and facing potential government cutbacks in Medicaid services and qualifications. And many older couples may not be physically able to take care of their spouse, so having long-term care insurance can relieve adult children from the burden of making decisions about their parent’s care, providing greater independence for both generations.

Long-term care insurance is designed to help policyholders cover out-of-pocket expenses for care in a variety of settings, typically home care, assisted living, adult day services, nursing homes and hospice care. Offered by several companies in New York State, coverage also may include care needed for individuals with cognitive impairment, such as Alzheimer’s Disease. LTC insurance policies also can provide flexible plans, including shared care for couples, and they are portable across states. LTC insurance policies include cost-of-living adjustments to protect against inflation and New York State offers a 20 percent tax credit for premiums, up to $1,500 for those with $250,000, and if you itemize deductions or own a business, there’s also an available federal tax deduction, which adjusts at different ages.

Nevertheless, LTC insurance policies can be costly, and premiums vary widely. There are a host of terms and conditions to consider in each plan, such as health qualifications, age, type of care covered, length of the benefit period, daily benefits, and “elimination period”—the length of time a person must wait before it pays the cost of care. Before purchasing a policy, it’s a good idea to consult with independent LTC experts to understand the nuances of various plans and determine which is best suited to your needs and most affordable. You can find local LTC insurance brokers and agents in your area who are members of the American Association for Long-Term Care Insurance on the association’s website (www.aaltci.org). Check their credentials, verify that they have complied with your state’s licensing and continuing education requirements, and ask for referrals.

You can purchase LTC insurance in New York up until age 79, but premiums are higher as you get older, and more important, your health may make you uninsurable. You should consider signing up for a policy “sooner, rather than later,” says Rona, especially if you have a family history of health issues. When you apply earlier, you pay less, both annually and cumulatively. (Adult children who are caregivers also should be thinking about LTC coverage, because they, too, will probably need such care as they age.)

Alternative Insurance Options

In addition to stand-alone LTC insurance policies, there are several alternative options, designed to help overcome some consumers’ “use it or lose it” objection to traditional long-term care insurance.  There are two kinds of policies structured around a life insurance model:

  • Hybrid policies. Also known as “asset-based” or “linked benefit” LTC policies, they provide long-term care coverage or a death benefit if the policy isn’t used to pay for long-term care. These are generally the most cost-effective life insurance-based products.
  • Life insurance policies with LTC riders. These policies are permanent life insurance policies with riders that allow policyholders to tap funds from their life insurance policy to pay for long-term care. Typically, a rider will pay some stated percentage of the death benefit, typically 1%, 2% or 3% of the policy death benefit each month.

There are two main categories of riders, known as 7702B long-term care riders, and 101(g) chronic illness riders. Policies with 7702 riders, as well as hybrid policies, are essentially guaranteed and tax-qualified long-term care insurance plans. Similarly, policies with 101(g) riders enable policyholders to receive accelerated death benefits tax-free for long-term care needs, but they are not qualified long-term care contracts, so guaranteed coverage and benefits may vary widely.

Whether your LTC insurance is a stand-alone policy, a hybrid or life insurance with an LTC rider, they may vary according to how their benefits are paid:

  • Reimbursement policies pay up to a daily or monthly benefit limit or amount depending on the cost of care. Any amount over the daily or monthly limit would be the responsibility of the insured. The advantage here is the potential to extend the policy life before reaching the payout maximum if the costs happen to be lower on the front end.
  • Indemnity policies pay a selected daily or monthly benefit as soon as you qualify under the claim. That amount is paid regardless of the actual cost of care, whether at home or in a facility.
  • Cash Benefit policies are similar to indemnity policies, with a particular benefit paid per day, although they offer more flexibility regarding the use of their disbursement "for anything or anyone" (including family caregivers). 

Benefits are paid when the insured is chronically ill, unable to perform two out of six “activities of daily living” (ADLs), or needs supervision due to cognitive impairment. ADLS include tasks such as bathing, caring for incontinence, dressing, eating, toileting or transferring—getting in or out of a bed or chair, for example. When these tasks become an issue, a medical review and an approved “plan of care” will begin the claim process. Once approved, the insured will likely have to pay out of pocket for long-term care services during the elimination period, although Medicare usually pays for up to 90 days.

Th of Partnership-qualified products in New York State. While there are no new Partnership policies available for purchase at this time, this does not affect people who are currently insured with Partnership-qualified policies.

Since many consumers do not actually use their long-term care policies for decades, experts often recommend checking the financial stability of potential insurers. Here are some firms that rate the dozen or so major insurers: A.M. Best Insurance Review (www.ambest.com); Fitch Ratings (www.fitchratings.com); Moody’s Investor’s Service (www.moodys.com); and Standard & Poor’s (www.standardandpoors.com).

One final note: Family members should make sure that their loved one’s LTC policy specifies who is authorized to speak to company representatives, should the policyholders become incapacitated and unable to speak for themselves. Most companies have personalized care coordination to help loved ones manage the process.

Here are some additional resources to help you navigate the many questions involved in choosing a long-term care insurance policy:

MEDICAID LONG-TERM CARE OPTIONS

Even though Medicaid, a federal health program administered by the states, is intended for low-income individuals, it is increasingly becoming a viable course for many middle-income seniors, as long as they meet a set of stringent asset and income limits. To fulfill Medicaid requirements, seniors often employ estate planning strategies to reduce their assets by making gifts to other family members or placing their financial resources into vehicles like “asset protection trusts.” Such strategies may enable families to qualify for Medicaid coverage for nursing homes, some assisted living communities designated as ALPs, or in-home care, known as Community Medicaid.

But these asset transference strategies are also subject to a Medicaid rule known as a “look-back period.”  That is, when a senior applies for long-term care Medicaid, their application will be reviewed to determine whether they have transferred or given away any assets for less than the fair market value during a certain time prior to the application—the “look-back” period. If Medicaid determines assets have indeed been gifted during the look-back period, it will impose a “penalty period,” based on the amount of the gift, during which the applicant will be ineligible for Medicaid services and will be required to pay privately for long-term care.

Currently, the look-back period is five years for applicants seeking institutional long-term care. Community Medicaid previously had no look-back period, but recently that changed. The Medicaid Home Care program in New York now has a 30-month look-back period, which was originally scheduled to take effect in 2020, but the implementation date has been pushed back several times due to the Federal Public Health Emergency issued during the pandemic.

The Arc New York

A related source of financial support for those who are already Medicaid recipients in The Arc New York (formerly known as NYSARC) a nonprofit organization that offers “pooled trusts” which qualify as supplemental needs trusts under federal and New York statutes. These trust services give people with disabilities and elderly individuals a way to maintain eligibility for Medicaid benefits even if their personal income exceeds Medicaid limits. Instead of paying their excess income to Medicaid, they can deposit it into a pooled trust, and those funds, in turn, can be used to pay for non-medical monthly living expenses and services not covered by Medicaid. This kind of trust can be invaluable for seniors who want to age in place, like my Mom, who was able to cover a significant portion of her monthly expenses (like her high electrical bills) so she could afford to stay in the home she loved. For more information visit www.thearcny.org.

Medicaid Planning Advisers

Medicaid rules, options, eligibility requirements, and exemptions can be complicated and confusing—and they can change, as in the case of recent revisions in the home care look-back period, needs assessment and other requirements. So when considering Medicaid, families should consult with elder law attorneys, financial advisers, or other experts who are up to date with the most current government regulations. And conversely, be aware that planning too far down the road also could be tricky, since government funding and regulations are continually under scrutiny by lawmakers in Washington and Albany.

A growing number of local experts, attorneys and senior advisers specialize in Medicaid planning, guidance and counseling services. These experts often can be located through professional organizations such as SUN (the Senior Umbrella Network;

Nassau Chapter: https://sunnassau.wildapricot.org;

Suffolk Chapter: https://sunsuffolk.wildapricot.org) and the

Long Island Chapter of the Aging in Place Council (www.ageinplace.org Click Local Chapters, then Long Island).

LONG-TERM CARE SUPPORT FOR VETERANS

The VA’s various services can help pay the costs of in-home care, adult day services, assisted living, or skilled nursing facilities for eligible Vets. Geriatric evaluations are conducted to assess a person’s needs and create a care plan. The VA does not pay for room and board in residential settings such as assisted living or adult family homes, but individuals can receive some services while living in a residential setting. The VA provides nursing home care if Vets meet certain eligibility requirements, such as level of disability and income. For much more information about long-term care topics, see the VA website’s Geriatrics and Extended Care page, www.va.gov/geriatrics.

LONG-DISTANCE CAREGIVING

While thousands of Long Islanders are caring for loved ones locally, many others are trying to care for elderly loved ones far away. For long-distance caregivers, what may have started out as a regular phone call to share family news often grows into a list of challenging responsibilities as parents become more frail—tasks such as obtaining medical information, managing finances, taking care of household chores, arranging monthly “check-up” trips, overseeing legal affairs, and eventually moving your loved ones to adult care facilities. 

The Navigator is designed to help caregivers find the support they need through government offices, social service agencies and nonprofit organizations in New York State and on Long Island. But much of the information for local caregivers also applies to long-distance caregivers, too. This resource guide can serve as a strategic tool for your family, no matter where your loved ones live.

Here are some basic long-distance caregiving tips:

Choose a Main Caregiver

Figure out who will take the lead caregiving role among the family’s adult children. A sibling who lives closest to an aging parent often becomes the primary caregiver, but they should discuss with other siblings how each family member can contribute or help out; an open dialogue is essential, as difficult as that can sometimes be. Long-distance caregivers can provide emotional support and occasional respite to the primary caregiver, as well as play a part in arranging for professional caregivers, hiring home health and nursing aides, or locating an adult care living facility.


Collect Critical Information

Learn as much as you can about your loved ones’ health and financial situations. To the extent possible, put all vital information in one place—a notebook, perhaps, in addition to a secure online document. This information should be organized and easy to reach in the event of a crisis. Include medical records, health insurance, financial and legal information, company names and phone numbers for utilities and other monthly service providers. Make hard copies and digital documents for various family members.


Secure Online Financial and Other Help

Caregivers also may find they can help manage their loved ones’ finances online—for example, paying monthly bills; purchasing and/or researching health problems and medicines; paying bills; or keeping family and friends updated. Some long-distance caregivers help a parent pay for care, while others step in to manage finances.


Create a ‘Circle of Care’ Contact List

Assemble addresses, emails and phone numbers of friends, neighbors, doctors, faith leaders and others—a “circle of care” around your parents who can be reached in the event of an emergency. These people also may be able to help out with shopping, transportation or visits. Consider including at least one person close by who can easily check in on your loved ones and give this person a key to the home if your loved ones approve. In some communities, mail carriers or utility workers are trained to spot signs of trouble through the Carrier Alert Program of the U.S. Postal Service. They report concerns, such as accumulated mail or trash, to an agency that will check on older adults. To find out if there’s a program in your loved ones’ area, contact the local post office.


Stay in Touch

Some long-distance caregivers might think the situation would be easier to manage if their loved ones lived closer. But many older people don’t want to move at all, facing the loss of old friends and familiar communities. Staying in contact with your parents by phone, FaceTime or email might not sound like much help, but often it is. If your loved ones are already living in a residential care community, several family members can participate in one phone call with them. Families also can schedule conference calls with doctors and facility staff to get up-to-date information about a relative’s health and status.


Identify Community Resources

long-distance caregivers often have trouble finding local resources and services for their parents. Knowing where to ask can make a huge difference. Searching online is often a good way to start, exploring websites such as the federal government’s Eldercare Locator (www.eldercare.acl.gov) which helps identify resources by topic, city or ZIP code. This service also offers information specialists who can help (1-800-677-1116) between 9 a.m. and 11 p.m. Caregivers can get help locating resources through the “area agency on aging” in their loved ones’ community. These agencies (on Long Island, they’re the Nassau County and Suffolk County Offices for the Aging) can be found on the Eldercare Locator site; just go to Find Help in your Community and type in your loved ones’ city or ZIP code.

And you might want to explore senior clubs and senior centers in their area—even if your loved one doesn’t want to join a center, these places can be a valuable provider of resources.

To learn about public assistance programs where your loved ones live, check out the National Council on Aging’s  www.benefitscheckup.org,  a free online service designed to help people over 55 search through more than 2,000 federal, state and private benefits programs to help pay for prescription drugs, health care, food and other basic needs.

Another option is to hire a private geriatric care manager. For a list of licensed professionals, searchable by ZIP code or city Aging Life Care Association website (www.caremanager.org). Even if you believe your parent or loved one needs some in-home care, be sensitive and respectful of their view of the situation. They may be reluctant to allow strangers in their home or they may have trouble facing such changes. Explain how various services work and that they are designed to help your parents remain independent.

 

Plan Your Visits

When visiting your loved ones, make use of the occasion to assess their current and future needs. Before the visit, decide what needs to be taken care of while you’re there, including purchasing household items, scheduling necessary appointments, going through financial and legal documents, and reviewing the home for comfort and potential safety hazards.

During the visit, think about your parents’ daily needs and whether they need more help on a regular basis. Take note of anything out of the ordinary. Are they eating well? Socializing with friends and getting out? Keeping up with chores or housekeeping? Maintaining their personal appearance and hygiene? Paying bills and responding to correspondence? If not, consider additional resources.

At the same time, make sure your visit is an enjoyable event. Set clear-cut, realistic goals. Remember, a visit that’s too much business or too strenuous won't be good for anyone.


Don’t Forget Your Own Needs

Recognize the stress that caregiving—whether local or long-distance—imposes on caregivers. Accept that may be impossible for you to provide all the help your loved ones may need. Give yourself credit for whatever efforts you and other family members can provide.  Ask for help when you need it. For more tips and resources to manage the stress of caregiving, see Part V of this resource guide (Caring for Yourself, the Caregiver).

The list of General Caregiving Resources (following “Family Conversation #1” in this section) also offers several organizations that identify resources by geographic area, so caregivers can customize their search for help to where their loved ones live.

The National Institute on Aging, a division of the National Institutes of Health, offers helpful, broad-based information about long-distance caregiving on its website (www.nia.nih.gov; click Health Information then Caregiving). You can download a free copy of the institute’s booklet, Long-Distance Caregiving: Twenty Questions and Answers, from its publications page (Click Health Information, then Get Print Publications).

WHEN THE UNEXPECTED HITS:

CREATING A ‘WHAT IF’ EMERGENCY PLAN

Things happen.

Violent storms. Serious accidents. The untimely death of a loved one.

This guide is designed to help prepare you in carrying out caregiving needs—before any crisis happens—but I recognize that’s not always possible. Despite our best efforts, unexpected events and emergencies arise, and we need to be able to mobilize fast to protect our family members.

Especially in an era of pandemics, the last thing we want to be doing is searching for critical documents, information, or items that we know our loved ones have somewhere—if we only knew where. To make these situations less stressful, you need to assemble the really important stuff in a safe place that can be quickly accessed by several family members. It’s a sobering reality but be prepared for the likelihood that one parent will die first, leaving behind a spouse—as was the case in my family.

Here is a short list of steps for you and your loved ones to put together a quick emergency preparedness plan:

One of the best crisis planners I’ve known, my late friend Linda Fostek, noted that “people think they have time, that a crisis won’t happen to them.” They know that an emergency plan is important but until it’s urgent, it’s not on their to-do list. ”You need to think ahead to have better options in case of a crisis—or even in the course of normal life planning. “If you have an emergency plan,” she said, “it works for everything.”