Brian Tracy, veteran motivational and business guru, writes often about the 80/20 Rule which provides that 20% of virtually all of our activities provides 80% of our results. (Make that link a must read if you haven’t seen it before.) Recently I read a post about the 40/70 Rule which provides: if you’re an adult child age 40 or if your parent is 70, it’s definitely time to have “the conversation”.

The article provided a quick overview of the challenges we face as adult children when our parents begin to fail – hence, ‘the conversation’ – and how difficult it is for so many of us to think about these things, let alone start a conversation about them. (Check out this free guide for tips on how to approach the subject.) There were several other help sites linked in the article, one in particular struck a major personal chord: caregiverstress.com.

Last April, everything changed for my wife’s parents due to a fall. They were residing in an “independent living” building; daily help for my mother-in-law, who was failing physically and mentally, had been added to ease the strain on my father-in-law. We were holding it together with Band-Aids to keep them independent.

Safety

Falls had become matter of fact ending up in numerous visits to the ER and several hospital stays over a course of several years leading up to this point. My wife had been told well over a year prior that her Mother needed to be at a higher care level – try having that conversation with your parents. Naturally they resisted, and looking back we now see the two of them were also in cahoots about the matter. My mother-in-law, still cognizant enough to sustain the marital power she had over my father-in-law, knew if she kicked up a stink he’d give in to appease her because for him, that’s the only thing he thought he could/should do. We also found out they hid numerous mishaps from us along the way keeping secrets about lost valuables, additional falls and other things in kind. Add to that their natural resistance to giving into the foibles of old age, and you have a recipe for disaster.

The fateful fall occurred on our daughter’s 10^th birthday. We received a call at 7 in the morning from their caregiver telling us she arrived at their apartment to find my wife’s father on the floor, unable to get up and her mother hanging over the side of the bed incapable of helping him; they had been there all night. What ensued over the following weeks? Duel visits to the ER, interviewing and hiring a 24/7 caregiver, buying furniture to set up a second bedroom for the caregiver and unexpected back surgery for my father-in-law. This was the proverbial turning point; the live in caregiver started on a Monday, my wife’s father was admitted to the hospital two days later complaining of pain, and the caregiver gave notice on Thursday.

To say that we were unprepared and ill-equipped to handle a five alarm medical-care-giving-estate-management fire at a moment’s notice is an understatement. One saving grace was that my in-laws had executed medical and property power of attorney to my wife which empowered her to hire two 12 hour shifts to watch her mother while riding shot gun over her father’s morphine induced antagonistic pre and post surgery hospital stay.

The ultimate blow was delivered post-op week in rehab at a nursing facility; her father was diagnosed with vascular dementia. 36 days had now passed since the fateful fall and major changes had to be made; my wife was forced to do what no child wants any part of – place their parents permanently into nursing care – at the same time. As if that emotional struggle wasn’t tough enough, the next 7 months became a whirlwind of sorting through and giving away their independent belongings, finding space to store things we kept, managing their facility care and creating a strategic plan for expenses and long term needs.

Security

In addition to the power of attorneys, my in-laws had executed wills, DNR statements and held a deed for cemetery plots. At first glance, we thought we were okay having heard stories from so many other people who loomed in kind but were unarmed with the tools necessary to step in when needed. It was a good start; but not an adequate one.

Right out of the gates, $17,000 had already been paid out to round the clock care-giving for my mother-in-law before she joined my father-in-law in nursing care and $8,900 went to the Elder Care Attorney for estate planning. This is one of the top things that troubled my wife the most; being responsible for spending her parents’ money. In my experience, the perception of money in hand and future need is a tough nut to accept and plan for which only magnifies with the effects of aging.

The most important takeaway piece of advice I can offer to all parents and adult children is this: unless your family is abundantly wealthy, it is imperative to plan ahead for “spend down”. Hundreds of thousands of dollars will fly out the window the moment you step into higher level care needs; whether help is brought into the home or paid to facility care. In death, arrangements must be made, there is no choice; with health directed living, there are choices upon choices to consider, shop for and execute.

Timing is the key; how much money will your parents need to exist? Over one year? Over two years? Or longer? What will happen if your parents outlive their money? The average nursing home stay is several years; my wife’s paternal grandmother lived the last 15 years of her life in a nursing home. I say this not to invoke fear but to lay emphasis on the crucial need for pre-crisis financial and estate planning.

In our case, ‘spend down’ began when home care was added. My wife liquidated small assets at first; a CD here and there and small mutual funds. A total liquidation of all assets ensued for estate and Medicaid planning. Some people were surprised to hear we were planning for Medicaid; my wife’s family wasn’t wealthy, but certainly not indigent. Herein lies the second most valuable piece of advice: apply for Medicaid before your parents’ funds runs dry to insure they’ll be taken care of.

Extended living options have grown leaps and bounds over the last decade. There are facilities which offer multi-level care opportunities from single family homes to nursing care accommodations all within the same campus area. These are the type of plans that typically require handing over the total value of one’s estate up front. Alternatively, whether your parents are still in their own home, living in independent senior housing or in assisted living, there is no extended living luxury; if/when their money runs out, they will ultimately have to evacuate. That is the fear factor; who/where/how will your parents be taken care of then?

Equally important is the fact that nursing homes want residents to enter on a “private pay” basis for a prerequisite time period before they are forced to accept lesser rates paid by Medicaid. Some homes we researched required as much as three years’ private pay for new residents. This makes seeking pre-approved Medicaid status extremely time sensitive, especially if you are already in spend down mode. Every piece of financial and health related documentation from your parents’ desk drawers, storage closets, safe deposit boxes, and via microfiche request if need be (it was) for a period of 3-5 years is required for Medicaid review. This process can turn around in as quick as 90 days and take as long as 18 months; it was a six month endeavor for us.

If you are thinking to yourself about now that ‘no way in hell will my parents ever leave their home’, there is one alternative option: long term care insurance. Yes, it’s not cheap, but in comparison to medical living expenses it is the only way to ensure staying at home.

Ten years ago, my father-in-law wanted to get long term care; my mother-in-law freaked at the $5,000 annual premium rejecting the idea. The difference between what would have cost $5,000 a year for the last ten years vs. the $13,000 a month they spent living independently with day time care giving, which now goes to nursing home expense, is astronomical. Without long term care, the costs to stay at home as opposed to facility living are more lateral than you would think.

When you do get to the point of crunching numbers, please enlist the help of financial and legal advisors. The plethora of medical and money issues will be overwhelming without the help of  seasoned professionals to aid in tax, estate, medical and daily expense planning. There is also a wealth of established senior referral and help centers available to assist families with finding reputable care givers and living accommodations; most of which are freely offered.

Sanity

A recent survey provides that a third of Boomers say they’ve never been able to grow beyond the role of child with their senior parents to begin with. For these adult children, talking about and planning for their parents’ long term needs is even more challenging. Conversely, while many Seniors are routinely vocal about not wanting to be a “burden on their kids”, they retreat when it comes to pencil pushing the subject.

My wife and I wouldn’t wish our experience on anyone – a little lead time would have saved our sanity – but we are very thankful we had enough time to secure my in-laws’ living needs. Would we have been able to move things along quicker/easier had we been more Sherlock Holmes like with my in-laws at the first signs of failing independence? Possibly, yes; probably, we’ll never know for sure.

In retrospect, the birds and bees talk is way easier to deal with than the conversation. Please share our story with your siblings and your parents; sometimes it’s easier to example others first to get the ball rolling.

Kurt Rusch, CLU, ChFC