Guide to Caring for Elderly and Aging Parents

learn about dealing with elderly parents as they age
Learn about dealing with and caring for your elderly parents as they age

When it comes to caring for elderly parents, there are a number of options out there. Your first decision is where your parent will live – in his or her own home, with you, or in an elder care facility. If you choose elder care, your choices extend to adult day care, home care, independent living, assisted living, or skilled nursing care.

After you’ve made this basic but life-changing decision, you and your parent must make many other preparations. It’s time to talk healthcare, financial and medical Powers of Attorney, wills and living wills, insurance, and day-to-day concerns like paying the bills and managing assets. These arrangements will pave the way for smooth transitions for both you and your parent, and will cross the T’s and dot the I’s on all necessary legal matters.

On a personal front, you must adjust to your new role as caretaker – as playing parent to your parent. Remember that this stage of life is difficult for both of you. Grant yourself some leeway as you adapt, and adopt strategies to make life easier for yourself and your aging parent. It also helps to stay organized, so we’ve created a handy checklist for looking after elderly parents, that we hope you’ll find useful.

Elderly Parents and Their Finances

The cost of elder care can be daunting, and for some families out-of-home care is simply an impossibility. According to the 2011 MetLife Market Survey of Long-Term Care Costs, the cost of caring for aging parents is the following:

  • Nursing home (Semi-private room): $214/day or $78,110 per year
  • Nursing home (Private room): $239/day or $87,235 per year
  • Assisted living: $3,477/month or $41,724 per year
  • Home care (Home health aide): $21/hour or $21,840 per year
  • Home care (Homemaker): $19/hour or $19,760 per year
  • Adult day care: $70/day or $18,200 per year

When evaluating your options to care for an aging or elderly parent, the very first question you should ask is: What can my family afford and what can we tolerate? The key is in finding a compromise that is both economically sound and emotionally doable – for your parent as well as you, your spouse or partner, and any children that live with you.

Begin assessing your parent’s financial situation. Many senior citizens receive Social Security, which pays retirement, disability and family benefits. However for most seniors, the maximum monthly benefit falls short of assisted living or nursing home care, and is often less than required to meet monthly expenses, even when living at home. In this case, your aging parent must have a private retirement plan, investments, assets or other sources of income to cover monthly living expenses.

As the child of an aging parent, it is your responsibility to understand your loved one’s finances. This can be a confusing topic, since it incorporates issues like Social Security taxation, wills, trusts, and reverse mortgages. For more information, please review our Senior Citizen Financial Guide and contact your attorney.

Health Insurance Options for Aging Parents

Medicare

Seniors aged 65 and older are eligible for Medicare if they or a spouse have worked in Medicare-covered employment for at least 10 years, and if they are permanent residents or citizens of the United States. For more information on whether your parents are eligible for Medicare, visit www.medicare.gov.

Medicare recipients are responsible for sharing the costs of benefits, and may be required to pay deductibles, copayments, co-insurance and premiums. However, Medicare costs are billed depending on a senior’s financial resources. If your parent is also eligible for Medicaid, Medicaid may help pay their Medicare costs. If they have limited income, your state or Medicare may help cover the costs.

Basic Medicare coverage is sectioned into Part A and Part B. Part A, also known as Hospital Insurance, covers all or part of inpatient hospital care. For aging parents, it is very helpful in that it also covers home health care, skilled nursing facilities, and hospice care. Part B Medicare, or Medical Insurance, is your standard healthcare, covering doctor’s visits, medical equipment, outpatient care, certain preventive services, and home health care. Medicare Part D pays for some prescription drugs. Medicare will not pay for long-term healthcare (aka custodial care), routine eye care, routine dental care, dentures, routine foot care, or hearing aids. Additionally, it does not cover cosmetic surgery or acupuncture.

Medicare Part C allows your parent to obtain Medicare benefits through a private company. For most seniors, Part C will include Part A, Part B and Part D Medicare.

Seniors and the Affordable Care Act

For seniors with Medicare, the Affordable Care Act ensures that their benefits will never be reduced or eliminated. Additionally, your parent will always have the ability to choose his or her own doctor. Furthermore, a free annual wellness exam is now covered, and Part A Medicare will pay for certain preventive services (no Part B requirement or coinsurance). Regarding prescription drugs, if your parent is in the “donut hole” – a coverage gap for prescription drugs – the Affordable Care Act allows a 50% discount on certain brand-name medications. The donut hole will close by 2020.

If your elderly parent is not eligible for Medicare, the Affordable Care Act works to provide health coverage that you or your parent can afford. For more information on Medicaid, community health centers (free or sliding-scale care), private health insurance, and pre-existing condition insurance plans, visit http://www.healthcare.gov/news/factsheets/2011/08/seniors.html.

Caring for an Elderly Parent at Home

According to the MetLife Mature Market Institute, almost 10 million adult children are providing long-term care for elderly and aging parents. Caring for your aging parents at home can save money or avoid expenses that your family simply cannot afford. But living with an aging parent can mean major changes for your family.

You’ll need extra space for your parent to live and roam, but it goes far beyond that. Does your loved one have special dietary concerns, such those of a diabetic? Will you have to adapt your home to the needs of a wheelchair-bound adult? Will you have to hire part- or full-time home health aids to tend to any special needs? Is your parent’s bathroom properly equipped with shower grip bars and toilet grab rails?

Inviting an aging parent to share your home is a financial, emotional and time commitment that will have a resounding impact on your lifestyle and day-to-day living. Be sure to make adequate and thorough preparations.

Power of Attorney for an Elderly or Aging Parent

Before an aging parent becomes forgetful, terminally ill, or has difficulty handling certain tasks, it is essential to set up a Power of Attorney, or POA. It is important to set up your POA before your parent shows any warning signs, as any individual must be deemed of sound mind to assign power of attorney.

You’ll need a durable power of attorney, which can go into immediate effect. Without a durable POA, if your parent becomes ill, you will not be able to make any medical decisions or even pay bills on his or her behalf.

There are two types of durable powers of attorney: a healthcare POA and a financial POA. A POA for healthcare gives you the authority to make any and all healthcare decisions for your parent. True to name, a POA for finances will give you the legal authority to make financial and legal decisions for your parent.

If you have siblings, you can all be given power of attorney, either individually or jointly. If you hold joint power of attorney, your POA will specify whether decisions must be unanimous. Additionally, in order to prevent abuse by any individual, the power of attorney may also require anyone exercising POA powers to answer to a third party. A POA can also prevent any member from changing your parent’s beneficiary designations of their life insurance policies, or from changing his or her will.

Read our interview with elder care legal expert Matt Parker for more information on elder care law.

Living Wills and Estate Planning for Aging Parents

Speaking of wills, this is also a good time to discuss your parent’s living will. This can be a sensitive topic for many, but it is an essential aspect of caring for an aging parent. A living will is a legal document that dictates your parent’s preferences for end-of-life health care. A living will goes into effect only when you parent becomes terminally ill. This document should include whether your mother or father is DNR – do not resuscitate – in the case of stopped breathing or a stopped heart.

Finally, if your senior parent does not already have a will, call his or her attorney immediately. This is one of the most important documents for any parent, especially elderly parents. There are several computer programs and websites that will allow your parents to craft a legal, binding will at home; or you can contact their attorney for estate planning help.

Dealing with Difficult Elderly Parents

The parent-child relationship is one of the most precious and precarious of all bonds we will form in our lifetime. Though we grow up, it can be hard to forgive past wrongs – or stop yearning to forge a better, stronger relationship. This can be particularly difficult as your parent age and Alzheimer’s or other illnesses take over, fogging the brain and in some cases removing the mind-to-mouth filter. See our Caregiver’s Guide to Alzheimer’s Disease for more information on Alzheimer’s and Dementia caregiving.

If you are caring for a difficult or abusive elderly parent, you may feel short on patience and long on suffering. Even the most easygoing parents can become a little trying in their old age. Here are a few tips for managing your relationship with the difficult, aging parents whom you love dearly but who are driving you to agitation.

Know Your Limitations

Caregiving is a time-consuming task that can be emotionally trying, especially if your loved one’s health is on the decline. The best thing you can do for yourself and your parent is establish boundaries to what you can and cannot do. Do not overextend yourself: if you cannot be the primary caregiver or you simply cannot perform certain tasks, say so. Then ask for help.

Forgive Your Parent, and Yourself

Difficult parents often strike out at those closest to them. Be compassionate. For your parent, senior status can signal a loss of independence and an impending end to life. For you, it is a sad and trying time, as you watch your once-vibrant parent age. Give yourself some slack. Forgive a sharp word or angry moment. You’re both entitled to how you feel.

Establish Boundaries

Sometimes the best thing you can do for an aging parent is say no. If your ability to care for a loved one is in danger due to constant complaining, sniping, physical abuse, or other behavior, speak up. Say, “I’m sorry, Dad, but I will not talk to you if you insist on name-calling.” Don’t be afraid to reinforce your boundaries, either. It can be disconcerting to invert the parent-child relationship, but in the end your ability and willingness to care for your parent is more important than maintaining the status quo.

Understand Dementia

Dementia can be one of the hardest conditions to understand, especially when your parent is in otherwise good physical shape. But dementia is a type of cognitive impairment and can have serious and sobering effects on an elderly parent’s humor, mood and even personality. If your loved one suffers from dementia, he or she may not be able to express gratitude. Your parent may become paranoid, suspicious, or nasty. Remind yourself that it’s not your parent speaking; it’s the illness. This knowledge will lessen the sting.

Take Some “You Time”

Do you feel guilty taking time to yourself? Don’t. Sometimes we get so caught up in our day-to-day lives and taking care of our children, our spouses and our parents that we forget to take care of ourselves. Over time, being constantly on the go will run you down and deplete your energy. Exhaustion will lower your immune defenses. And you’ll probably end up feeling overextended, overworked and under-appreciated. Before that happens, take some time for yourself. It can be as simple as taking a leisurely walk or as indulgent as getting away for the weekend. Do what you need to recharge your batteries.

Checklist for Caring for Aging Parents

General Considerations

  1. Gather your parent’s personal information:
  • Full name
  • Date of Birth
  • Social Security Number
  • Phone Number and Address, including legal state of residence
  • Marital Status
  • Health Status
  • Names and Phone Numbers for your parent’s physician, attorney, geriatric care manager, and other important persons
  • Phone Numbers for family members and your parent’s close friends
  1. Review your parent’s financial situation and data:
  • Income sources (Social Security, pension, dividends, current employment, etc.)
  • Monthly and yearly expenses
  • Assets
  • Liabilities, loans, liens, etc.
  1. Have you discussed whether your parent is still able to drive solo? Drive alone at night? Is your parent’s driver’s license current?

Estate Planning and Legal Issues

  1. Does your parent have a will? Is it up-to-date?
  1. Does your parent have a living will? Do you know his or her position on DNR?
  1. Have you prepared all advanced directives, including durable power of attorney?
  1. If your parent’s assets will be subject to estate tax, have you spoken with an attorney on how to minimize these expenses?
  1. Has your parent prepared proper letters of instruction?
  1. Have you discussed funeral arrangement and other end-of-life decisions?

Healthcare and Insurance

  1. Have you established a POA for healthcare?
  1. Does your parent have long-term care insurance?
  1. Does your parent have sufficient health insurance? (Private care, Medicare, Medigap, Medicaid, etc.)
  1. Does your parent have life insurance?
  1. Does your parent have other types of insurance? (Homeowners, auto, umbrella liability, etc.)
  1. Do you have a complete list of your parent’s daily medication schedule?

Senior Housing

  1. If your parent still lives independently, have you prepared a repair and maintenance checklist?
  1. Is your parent’s living situation safe and comfortable? If they have trouble negotiating steps, is one-level living possible? Are doors wide enough to accommodate a wheelchair, if necessary?
  1. Have you discussed your parent’s housing options and preferences? (Read more on senior housing options with our Ultimate Guide to Senior Housing)
  1. If a change in housing is required, have you discussed your parent’s preferences and reached a satisfactory agreement?
  1. Does your parent currently require home nursing care?
  1. Does your parent require skilled nursing care?
  1. Have you discussed the possibility of adult day care?

Financial Decisions

  1. Does your parent have sufficient income, pension and/or savings to support his or her lifestyle?
  1. Is your parent of sound mind to make financial decisions?
  1. Is your parent’s asset allocation suitable?
  1. Have you established a POA for finances?
  1. Does your parent need to consider Medicaid?
  1. Will your parent be dependent on you, your siblings, or other family members for financial support?
  1. Do you or other family members have sufficient financial resources to support your parent, if your parent cannot support himself?
  1. Should you or other family members’ names be added to bank, utility and other accounts?
  1. Has your family discussed and decided upon distribution strategies?

Other Considerations

  1. Have you prepared with your parent a list of important records, documents, and other credentials? These may include:
  • End-of-life paperwork, including a living will, will, letters of instruction, and advanced directives
  • Identifying information, such as a birth certificate, marriage certificate or divorce certificate
  • Citizenship records
  • Passport
  • Military records
  • Investment records, including stock certificates and bonds
  • Bank account information, including checkbooks and bank statements
  • Retirement plan information
  • Income tax records (at minimum, for the previous three years)
  • Credit card statements
  • Monthly bills
  • All property ownership records, including mortgages, real estate deeds, and car titles
  • Business agreements
  • Medicare and health insurance policies
  • Other insurance policies
  1. If your parent owns interest in a business, have you already discussed his or her wishes in the case of legal incapacity or death?