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May 27, 2018
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When the time comes: On managing all aspects of a family members’ life

By: Julie Ann Soukoulis
March 30, 2018
Navigating the aging journey

Family members have been calling frequently to check on grandpa. One day - he doesn’t answer the phone. He’s been answering up until now - and so no one has gone by to see him for a while. When we call - he tells us “I’m fine - you guys know I’m always fine, but thanks for calling!”

Anyone taking on such a critically responsible role needs to do it with the idea of full-in and full-on. A person’s life is not something that can be done when we have an extra few hours here and there. Home management was being handled until this clarion situation that called in the siblings and grandchildren suddenly manifested.

Grandpa is not the same. When family went to check on him the house smelled like spoiled food. His laundry was no longer being taken care of, something he used to do religiously. He was thinner and seemed confused. Turns out he cannot even hear the phone - he had been watching it for the light to go on when the ringer sounded.

What to do now?

Stepping up and stepping in

From ample amounts of household supplies, to utilities and insurance bills, from doctors’ appointments and prescriptions, to dealing with the management at an assisted living facility, to managing their investment portfolio - families may be completely clueless as to how much needs to happen to keep grandpa’s affairs not only in order - but able to be properly managed until his death.

Obviously, the most important thing is having someone that is willing and able to take on this oversight role. And whereas some family members may be willing - they may very well not be capable.

It takes a whole lot of organization to ‘operationalize’ all the aspects of another person’s life. However, with a good set of processes established - everything can actually run on autopilot.

Managing the cash flow

The main goal is to ensure that grandpa or grandma live comfortably and stress free - while the rest of the family is making sure they will not outlive their assets. And while many family members convince themselves that the most comfortable, stress free environment is an assisted living facility - this may not actually be the case.

If an elder has lived in their own home for several decades - the routine and familiarity of this is what gives them the handrail needed to pull themselves forward every day. Having the same family faces, friends if they are there, and anything else that keeps things “normal” are what is needed most.

The best chance to avoid a deep decline in cognitive functioning for an elder in their late 80s is to keep things as much the same as is humanly possible. In order to avoid the tremendous cost of a skilled nursing facility (this comes after they fall and break a bone) you should get help into the home to prevent this inevitable crisis.

Compare the costs

As many of you know, assisted living can cost $5K/month or more (depending on the level of care needed and the location in the country). And while most of our grandparents have reasonably sized portfolio’s, most of them don’t generate enough cash flow to enable living off the dividends / interest without touching the principal.

Elder portfolio’s need to be very conservative in manner so as to generate reasonable cash flow while ensuring it isn’t too negatively impacted by a market downturn. Keep portfolio’s as simple and consolidated as possible. Only use a few funds and ETFs.

For example, choose an income fund that provides a conservative balance of equities and bonds with a low expense ratio.

Estimate an approximate four percent return on a conservative portfolio - and account for an average seven percent increase in the annual cost of assisted living. Also include associated expenses. It doesn’t take too long to identify when their portfolio will be exhausted.

Also consider the benefit of hiring in home care for several hours a few days a week to provide security, supervision and companionship. 

In home care proves extraordinarily effective for keeping elders stable, comfortable and not under stress as regular activity in the home feels welcome. Familiar faces are needed because isolation is a leading cause of elder decline. Paying around $40 an hour for stability pales when considering the costs of hospitalization after a preventable fall. In-home care is fall prevention and stabilization security.

Consider our economic culture

It is certainly scary to think that the seniors in our society who are fortunate enough to live to be 80 plus and live in assisted living - are still confronted with the possibility of outliving their nest egg in their final years. From the elder’s perspective they are working to prevent strain on the family - and so may choose this option when it isn’t always the best.

One aspect of maximizing income can often be the option of having a grandmother take advantage of her spousal veteran’s benefits. The government doesn’t have a look-back period on veteran benefits. Medicaid does have a five-year look-back period.

And there are many things that can be done to minimize unnecessary expenses.

Note: To receive Medicaid coverage while in a nursing home, an individual can have no more than $14,400 in countable resources. Assets, such as a home or retirement accounts, are exempt in some circumstances.

The idea is to give away your assets to loved ones to qualify for government assistance before the five-year look back period begins, or else you will be disqualified. 

 *Unfortunately this approach means that wealthier people get beds in Medicare qualified facilities when those in perhaps even more dire need are still waiting for the bed to become available.

A few expense reduction opportunities:

1. Evaluate Medicare Prescription Drug Plan (PDP) options on an annual basis – identify if there is a more cost effective plan based on the latest medications that they are taking.

 2. Purchase grandma/pa a big button cell phone with a basic $10/month plan – tether it to their wheelchair so that it is always available for a call. Cancel the landline and save $20-$40/month in unnecessary phone costs.

 4. Negotiate with assisted living – this is not always effective - but try to have the assisted living facility reduce the annual increase as much as possible. Try to get them to reduce the increase from seven percent to five percent, as that can make a marked impact.

Maintaining your loved ones’ quality of life for as long as possible

If they cannot stay in their home and they can’t live with you - try to be close enough that you can visit your loved one a lot. Get to know the staff and the daily workings of the assisted living facility.

No one cares about your loved one more than you. Therefore, if you are visible and the staff knows you, immediately course correct if something is not to your liking. Ensure that your family member’s quality of care is prioritized. Know that a bedsore is a sign of neglect and can eventually cause death.

A practice run for your own retirement

Today long-term care insurance is much harder to get because it doesn’t pay off well for the insurer. This means you need to know how to create a safety net around your own aging plans. 

Do you want to die in your own bed or bedroom? This needs a clearly articulated plan with a palliative/passive death instruction included. This is what is recommended by most hospice companies.

Once your loved one realizes that you genuinely have everything under control, they will be willing to let go and enjoy their days without worrying about the details.

 Local resources to support todays discussion: Legacy Concierge Services , Providing Families of and Elder Households with Superior Advisory and Resource.707-732-4527 www.legacyconciergeservices.com . Tweeten Eldercare Advisors, they specialize in helping you navigate the complex maze of care alternatives either at home or in a community setting such as an assisted living community or licensed care home can be reached at www.tweeteneldercare.com (707) 570-2589.  Last resource but not least valuable are our local Hospice organizations:  Hospice by the Bay www.hospicebythebay.org or Petaluma Hospice at www.sonomacountyhospice.org 

Julie Ann Soukoulis is the owner of Home Instead Senior care office in Rohnert Park, mother of two and passionate about healthy living at all ages. Having cared for her own two parents, she understands your struggles and aims, through her website,www.homeinstead.com/sonoma to educate and encourage seniors & caregivers. Have a caregiving or aging concern? She’s love to hear from you at 586-1516 anytime.