FAMILY CAREGIVING GUIDE
PLANNING FOR YOUR LOVED ONE WITH YOUR LOVED ONE
Wealth | Investments | Planning Commerce Trust Company
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TABLE OF CONTENTS
GOALS FOR YOUR LOVED ONE 2
PLAN BASICS 3
PERSONAL DECISIONS 4
HOUSING DECISIONS 4
HEALTH DECISIONS 5
FINANCIAL DECISIONS 6
GATHERING RESOURCES 7
SETTING THE PLAN IN MOTION 7
Family caregiving has become more complex, costly, stressful and demanding than at any time in history. Planning in advance – or at least being cognizant of the issues and challenges that may be faced – is becoming increasingly important as the population continues to age. As part of our efforts in helping provide information to guide families through challenging life events and financial situations, Commerce Trust Company is happy to provide this material for your benefit. Important Disclosures The information provided here is for general informational purposes only and should not be considered an individualized recommendation or personalized advice. Each individual or family needs to review the material in the context of his or her own particular situation before making any decisions. All expressions of opinion are subject to change without notice. Data contained herein from third-party providers is obtained from what are considered reliable sources. However, its accuracy, completeness or reliability cannot be guaranteed The information provided herein should not be considered legal, medical or financial advice. Please consult an appropriate expert if you need specific advice. INTRODUCTION Caring for an aging parent, elderly spouse, domestic partner or close friend presents difficult challenges – particularly when a crisis hits and you are suddenly faced with immediate responsibilities or decisions. You may be the only person available to step in, or you may be the focal point for family members and friends willing to help. Whatever the situation, you may not be sure of the next step, or even the first step. Why is this an important issue for discussion? 1 ■ One American in six currently lives in a multi-generational household. ■ Twenty percent of households are involved in caregiving to someone aged 18 or over. ■ One-fourth of people age 45 and over say they are not prepared financially if they suddenly required long-term care for an indefinite period of time. Family caregiving is multifaceted and requires those involved to understand and make decisions both large and small. Caregiving roles can take countless shapes and forms, and can often be overwhelming and confusing. Without a discussion beforehand, the stress of something unexpected happening can be real – whether it’s financial, legal, emotional or even within family relationships. This document can serve as a guide for having what may be one of the most important discussions a family can have.
1 Family Caregiver Alliance, February 2015
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GOALS FOR YOUR LOVED ONE
Before plans are set, a great place to start is by understanding what your loved one’s goals are for this phase of life as well as any specific caregiving goals he or she may have. Use the “Goals Worksheet” below as the basis for talking about priorities. While you may not have all the answers, be realistic when looking at the resources needed and whether the goal is realistic and attainable. There are resources at the end of this guidebook that can help in your discussions.
EASE OF ATTAINMENT
To live in my own home and remain independent for as long as I can.
If I can’t live in my own home, I would like to live .
To move to a smaller home.
To move closer to
To travel to
To remain active by doing
To work for as long as possible in my current job or by working in .
To take classes in focus on the hobby of
To become more involved in my community by volunteering at .
To be able to help my loved ones do
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Once you have talked through the Goals Worksheet, set aside some time to work through each area in more detail. There are worksheets provided at the end of this guidebook to capture the information you gather during your conversations; make sure you review the information with others to ensure everything is accurate. Pay attention to the small details to avoid mistakes or confusion that may be problematic. Remember that having this plan allows others involved in the caregiving process the peace of mind that actions and decisions have been thought out in advance.
FINANCIAL DECISIONS What is the financial situation?
PERSONAL DECISIONS What level of care does your loved one need?
What income can pay for caregiving?
What can your loved one do for themselves?
Is there long-term care insurance?
Are any other benefits available?
Who will be on the caregiving team and what will their roles be?
Who can access financial information or make financial decisions?
What is the contact information for advisors?
HOUSING DECISIONS Where will care take place?
Where are passwords and important documents located?
Should assisted living be considered?
Should a nursing home be considered?
What other services are available?
GATHERING RESOURCES Find out what resources are available at the federal, state, and local level. Build a support team for your loved one and for yourself.
HEALTH DECISIONS What health insurance is there?
Who are the medical caregivers?
What directives are in place?
Are there final wishes to consider?
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WHAT LEVEL OF CARE DOES YOUR LOVED ONE NEED If he or she wants to stay active and independent while living in their own home – and is able to do so – that’s great! However, it may not be the case, and those issues and needs should be addressed in the caregiving plan. If you are unsure about what level of care is actually required, having a conversation or evaluation with a professional is likely the best thing to do. WHAT CAN YOUR LOVED ONE DO FOR THEMSELVES Are there exercises, social activities, and lifestyle changes that can be done to maintain independence and health? Setting those things in motion now can help maintain a higher quality of living. WHO WILL BE ON THE CAREGIVING TEAM AND WHAT WILL THEIR ROLES BE Make a list of people who might be available to help, and understand the duties they may be willing to help with. To help avoid conflict or an uncomfortable situation, it’s best to discuss with your loved one whether that is acceptable to them. HOUSING DECISIONS WHERE WILL CARE TAKE PLACE Depending on the level of care required, home modification may be in order (hand rails, stools, grabbers, etc.). If the required care is more intensive, care providers may need to come to the home. SHOULD ASSISTED LIVING BE CONSIDERED If the situation requires more care than what can be provided at home but a nursing home facility isn’t needed, one option to consider would be local assisted living facilities. Assisted living facilities have a broad range of services and a facility should be matched to the kind of care your loved one needs. If you are unsure as to what kind of care your loved one needs, a health care professional can help determine the level of support needed. SHOULD A NURSING HOME BE CONSIDERED Nursing homes are not only for the elderly; they are for anyone who needs 24-hour care. Take the time to fully research the different types of facilities available and which ones in your area is the best fit. It is important to visit on different days, and during different hours, to get a good feel for daily life at that nursing home. Finding the best fit takes time and patience. WHAT OTHER SERVICES ARE AVAILABLE If your loved one is able to stay at home, take the time to find out what other services may be available in their home and in the community. In-home care can range from housekeeping and yard maintenance to meal preparation and bathing. There are community services available that help with transportation services, among other things.
Over 14% of adults in the U.S. have been the caregiver in the past year to someone over the age of 50. 2
2 Caregiving in the U.S. 2015: A Focused Look at Those Caring for Someone Age 50+, AARP with the National Alliance for Caregiving, June 2015
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WHAT IS THE FINANCIAL SITUATION While finances can be a difficult subject for many people and families to discuss, it is the central point from which many of the caregiving decisions will be made. The best solution is to make sure potential costs are taken into account. Ensure that bank accounts, investments, insurance coverage and loans are reviewed. Talking with a knowledgeable financial advisor can be helpful in aligning resources and needs. WHAT INCOME CAN PAY FOR CAREGIVING As you determine what kinds of care are required, you need to also understand what sources of income are available to pay for it. Are there pensions, 401(k) accounts, IRAs, Social Security income, etc.? Or does your loved one have to sell their home if they need assisted living or nursing home care? IS THERE LONG-TERM CARE INSURANCE Does your loved one have long-term care insurance? While it can be expensive, most people are surprised to learn that most insurance (including Medicare and Medicaid) may not fully cover the cost of in-home, assisted living or nursing home care. Conditions that more commonly require long-term care, such as Alzheimer’s, are most often diagnosed at an older age. The care – and expenses – for custodial and personal care may not be covered by Medicare, Medigap, or private health insurance plans. ARE ANY OTHER BENEFITS AVAILABLE Your loved one may be eligible for government and other benefits you didn’t know existed or that haven’t been filed for. Go to the resources section at the back of this guidebook for websites where you can learn more as benefit eligibility is different for every person. WHO CAN ACCESS FINANCIAL INFORMATION OR MAKE FINANCIAL DECISIONS In the event that your loved one can’t make financial decisions for themselves, it may be beneficial to have him or her appoint a financial representative. If you feel this is necessary, get a HIPAA financial release drafted so the representative can talk with financial advisors. Whether a financial representative is appointed or not, make sure it is understood who has access to all pertinent financial information for your loved one.
WHAT IS THE CONTACT INFORMATION FOR ADVISORS Is there a list of all advisors (including financial, insurance, legal, etc.), along with their contact information? If not, begin to gather that information and keep it updated on a regular basis. WHERE ARE PASSWORDS AND IMPORTANT DOCUMENTS LOCATED Write down a list of important passwords as well as the location of important documents and the location of any safe deposit box key(s). Be sure to put the list in a safe and secure place. Many individuals and families prefer not to discuss their estate or finances among themselves. If they really don’t feel comfortable discussing the particulars, suggest that they discuss the details with the executor of their estate. It is important that you let them know you just want to make sure they will be taken care of. That way, someone on the caregiving team is aware of the financial situation.
Research from HealthView Services and Fidelity show that the average 65-year-old couple will pay approximately $280,000 in out-of-pocket costs for health care during retirement.
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GATHERING RESOURCES Gathering information and making decisions are among the largest parts of formulating a caregiving plan, but don’t forget about collecting information on additional resources as well. Many communities have resources available that can help you find programs and services that assist with housing, food, financial support and even social activities. You can find out about services through Area Agencies on Aging (AAAs) and local organizations by going to the Eldercare Locator at www.eldercare.gov or calling 1-800-677-1116. While you have been focusing on the health and well-being of your loved one, don’t forget about yourself ! Changes in health care have placed increased costs and responsibilities on families, who are being asked to shoulder greater care burdens for longer periods of time. The role of a caregiver can be exhaustive – emotionally, mentally and physically. Find a support network that can include friends, family or community caregiver resources. The Eldercare Locator has lists of support groups and other resources that can be part of YOUR support team. SETTING THE PLAN IN MOTION After the information has been gathered, you may realize that there are still some gaps. Maybe some of the legal documents are outdated, or financial advice is required. In order to make sound decisions, consider meeting with an estate-planning attorney or a financial advisor. Finally, this can also be a time of reflection for your own future plans. How are you set up for retirement? Will you be able to support yourself when the time comes for your care? How much of your financial future will be affected by caring for a loved one? What steps do you need to take to deal with these issues?
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Answer & Notes
1. What level of care does your loved one want/need now, and will care need to be increased in the future because of progressive medical conditions?
2. What things can your loved one do for himself or herself to keep active and independent?
3. Who will be on the caregiving team and what will their roles be? Caregiving Member #1 Name: Relationship:
Duties: Caregiving Member #2 Name: Duties: Caregiving Member #3 Name: Duties: Caregiving Member #4 Name: Duties: Caregiving Member #5 Name: Duties: Caregiving Member #6 Name:
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Answer & Notes
1. Are there home repairs or modifications that need to be done to help your loved one maintain independence?
2. Is the level of care your loved one needs better suited for an assisted living facility or nursing home?
3. Does your loved one need assistance with housekeeping, shopping, or personal care?
4. What community services are available that could help your loved one maintain good health and independence?
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Answer & Notes
1. What insurance coverage is there, and what does it cover with regard to your loved one’s needs?
2. Where are his or her insurance cards, Medicare/ Medicaid information, and other important health documents kept?
3. Who are his or her medical caregivers and what is the contact information for each provider? Pharmacy Name: City: Contact Number: Doctor #1 Name: City: Contact Number: Doctor #2 Name: City: Contact Number: Doctor #3 Name: City: Contact Number: Doctor #4 Name: City: Contact Number: Doctor #5 Name: City: Contact Number:
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HEALTH DECISIONS (CONT’D)
Answer & Notes
4. Where are his or her important legal documents and are they up-to-date?
Will Living Will Power of Attorney
Medical Power of Attorney Do Not Resuscitate Order Trust
HIPAA Medical Release HIPAA Financial Release Other 5. Are there any other legal documents that need to be put in place?
6. Are there any final wishes that need to be articulated and understood?
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Answer & Notes
1. What kinds of financial accounts does your loved one have, and do you know the financial institutions where the accounts are located, including checking, savings, CDs, investments, etc.?
Checking Savings 1 Savings 2
CD 1 CD 2
Investment 1 Investment 2 Investment 3 Other 2. What sources of income does he or she have – pensions, 401(k), Social Security, IRAs, etc.?
3. Does he or she have long-term care insurance that may defray some of the costs of care?
4. Is he or she eligible for any other benefits, including VA benefits?
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FINANCIAL DECISIONS (CONT’D)
Answer & Notes
5. Who can access financial information or make financial decisions if he or she is unable to?
6. Who are his or her advisors (including insurance, legal and financial) and what is the contact information for each?
Insurance 1 Name: Insurance 2 Name:
Financial Advisor Name:
7. Are you aware of passwords, important documents for accounts, and the location of any safe deposit box key(s)?
Disclaimer: The information provided here is for general informational purposes only and should not be considered an individualized recommendation or personalized advice. All expressions of opinion are subject to change without notice. The information provided herein should not be considered legal, medical or financial advice. Please consult an expert if you need specific advice.
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ADMINISTRATION ON AGING www.aoa.gov Information on services and programs that may be of help to families and caregivers.
ELDERCARE LOCATOR www.eldercare.gov, 1-800-677-1116 A public service of the U.S. Administration on Aging connecting caregivers to services for older adults and their families. LONG-TERM CARE www.longtermcare.gov The U.S. Health and Human Services Department website that discusses long-term care, resources, and programs.
MEDICARE www.medicare.gov The government website describing the Medicare program and how to find plans and providers.
NATIONAL INSTITUTE ON AGING www.nia.nih.gov The government website containing publications and resources to help older adults, their family members and caregivers manage this new phase of later life. NURSING HOME COMPARISON TOOL www.medicare.gov/nursinghomecompare A tool on the Medicare website that lets you compare nursing homes and learn more about facilities in your area.
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Wealth | Investments | Planning Commerce Trust Company
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