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    Medicare

    Are you prepared to pay for your parents’ long term care?

    fressYour mom or dad may have decided to move to an assisted living residence or a nursing home if they need comprehensive long term care. The cost of this care can range from $5000-10,00 per month depending on their location and the extent of care. Unfortunately at some point they may run out of money to pay for these services. At that time they will need to apply for Medicaid, a program jointly funded by their state and the federal government, to pay for their nursing home care.

    In order to apply for Medicaid they must select a facility that is Medicaid approved. They must also meet the severe limitations on income and assets established by Medicaid. Medicaid funding has become a major budgetary issue for many states over the last few years, with states, on average, spending 16.8% of state general funds on the program. If the federal match expenditure is also counted, the program, on average, takes up 22% of each state’s budget.

    As baby boomers retire at the rate of 10,000 per day dependence on Medicaid is very likely to increase. At some point states may no longer be able to fund these increases. They may be required to implement the filial responsibility laws. These laws could hold children legally responsible for the long term care expenses of their parents. They are on the books in 30 states but have rarely been implemented.

    But recently the State of Pennsylvania enforced it filial support laws and found a defendant responsible for his mother’s long term care bill from a skilled nursing facility for $93,000. Other states may follow suit if their budgets get tighter.

    What does this mean for you and your family? This possibility makes it increasingly important that you have a conversation with your parents about their plans for long term care. You need to ask them three basic questions.

    1. If either one of them needs long term care do they plan to stay in their home?
    2. If either one of them is incapacitated who do they expect to be the caregiver?
    3. If they need long term care services how will they pare for this care?

    If initially your parents respond that this is really none of your business, you should tactfully answer that it may become your business. You can cite the case in Pennsylvania as an example.

    Your conversation with your parents may uncover their plans to stay at home if they need care. In that case they need to look carefully at their home to see if it safe for a physically limited person. You may learn that they expect your spouse to be their primary caregiver. This opens up a whole new area of conversation. You also may find that they have significant assets to provide their care or they have long term care insurance.

    You will not know the answers to these questions if you are afraid to engage them in this critical conversation. It all starts with three words… “Can we talk?

    How to Find a Doctor for Your Mother

    I have been reading Jane Gross’s wonderful book, A Bittersweet Season. It is about her efforts to care for her mother in her last few years. Jane writes a blog for The New York Times entitled, The New Old Age. Not only is the book a very personal account of Jane’s experience with her mother, but it is the source of a lot of valuable information on caring for an aging parent.

    One of Jane’s problems was finding a family doctor for her mother when she moved from Florida back to the northeast to be close to Jane. She found it almost impossible to find someone that would take her mother.  Jane learned  a few facts about the medical profession that made things so difficult. First of all, fewer general practice physicians are coming out of medical school. These doctors just don’t make enough money. The average GP makes approximately $150,000 a year and their  loans from school are around $200,000. A typical anesthesiologist makes $400,000 a year. So medical  students are choosing to become much more highly-compensated specialists.

    Secondly, many doctors are choosing not to accept Medicare.  They can legally opt out of the program. Reimbursement from Medicare for various procedures is far less than what doctors often receive from insurance companies. In addition, reimbursement is not for time spent with a patient but for procedures ordered. If a doctor convinces an older patient not to have her hip replaced, he does not receive a dime. Often older patients take longer in an appointment than younger healthier patients, which also ends up costing the doctor more.

    Given these issues, Jane was advised to take the following steps when seeking a new doctor for her mother:

    First, get a referral from her existing doctor where Mom is now, before she moves. That doctor probably knows someone in the area she is moving to. That doctor will most likely be reluctant to turn down a referral from a peer.

    Second, get tightly-crafted summaries from her existing doctor and any specialists that have been involved. Less is more. The new doctor is much more likely to read something that is clear and concise.

    Third, if you can’t get a referral, scout the area for doctors in the area where Mom is relocating, before she moves. Check with local councils on aging, senior centers, medical societies, and similar organizations.

    Fourth, make it clear to the new doctor that one adult child will be the conduit for all communication. He won’t have to field calls from two or three siblings who all have questions. Prepare a plan within the family as to how communication will be disseminated from that key person. Show the doctor that you won’t waste his time.

    Lastly, the same sibling should accompany Mom to medical appointments and communicate the results to the rest of the family. A family that manages itself internally is more likely to find, keep and get the best service from a doctor.

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    Reprinted from Bob Mauterstock’s The Gift of Communication Blog. Subscribe at http://www.GiftofCommunication.com  and receive Bob’s Family Meeting Checklist Guide.

    How to be by the bedside

    When one of your parents is very sick, you may not know what to do or expect. The time you spend with them by their bedside is very important. It is time that you will never forget. You may find it very difficult and very uncomfortable to be there but you will be glad you did it when it is over.

    People are very different in how they handle serious illness. You are just going to have to let them deal with it in their own way. They may just act the way you have always known them or they may seem like a totally different person to you. A lot depends on the type of illness they have and whether or not recovery is possible.

    Your loved one may be afraid of dying, tired all the time, confused, unwilling to have visitors, afraid to be alone, not wanting to talk, restless, depressed, or wanting to talk all the time. None of these actions are unusual. The best thing you can do is to be prepared for the unexpected. Your primary goal should be to make them as comfortable as possible.

    Just being there with your parent is the most important thing you can do. Do not worry about saying the right thing. You may even admit, “Mom, Dad, I don’t know what is the right thing to say to you. I just know that I want to be with you and I am happy to be here.”

    If your parent is sick they may want you to hold their hand, softly stroke their hair, read to them, play some music for them, show them photographs, tell them family stories, listen to them, pray with them or just sit quietly with them. Try not to upset them and assure them that they aren’t a burden to you.

    Be conscious of how long you stay. After awhile you will get a sense of how long is appropriate. If you notice them starting to close their eyes or lose concentration, it’s time to go. In most cases I would suggest not staying longer than an hour. Frequent visits are much more important than long visits. Don’t be offended if they tell you they want to be alone. Having family members visit you requires a lot of energy and can be very draining to those who are ill.

    As difficult as it may seem, imagine that this is the last conversation you may have with them. This will help you say everything you need to say.

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    PERMISSION TO REPRINT:
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    Financial Advisors may reprint any articles from The Gift of Communication Blog in your own print or electronic newsletter. But please include the following paragraph:

    Reprinted from Bob Mauterstock’s The Gift of Communication Blog. Subscribe at http://www.GiftofCommunication.com  and receive Bob’s Family Meeting Checklist Guide.

    Time to talk Turkey

    Many families gather together during the holiday season. This is the perfect time to have a meaningful conversation with your elderly parents. But many of us have difficulty opening up a serious conversation with them. Let me give you some suggestions that will help to get the ball rolling.

    The experts have told us that there are two things that dominate the thoughts of our elder parents. The first is the desire to maintain control over their lives, to be able to stay in their home, to continue to drive, to do what they want to do when they want to do it. But as their health deteriorates this is often hard to do. That’s when the second most important thought takes over.  “What will be my legacy? How will my family remember me?”

    2600 families with elderly parents were interviewed by the Allianz Insurance Company. 70% of them responded that discussing how the parents would want to be remembered by their children was a conversation important to them. But when polled, only 30% of the families had made the effort to do so.

    When was the last time that you asked your parents, “How do you want to be remembered by your grandchildren and great grandchildren? If you are willing to ask that question, close your mouth and just listen. And remember to listen carefully. Drop all your preconceptions of what they will say and how they will say it. Listen with an open heart.

    But if you are not willing to open with that question, I suggest you start with a question that everyone is willing to answer, “How did the two of you meet?” That one was a shocker for me. When my mom was moving into assisted living I reviewed with her the important documents  that she held in a metal box. Amongst her legal papers, was an envelope marked “ Letter from Bob while overseas” This was a seven page poem that my father had written on his way across the Atlantic to fight at Normandy in the D-Day invasion. It was in perfect condition. It described how my parents met and their courtship and marriage. I was surprised to learn that my mother, at age 15, ( in 1930) had called my dad to take her to a party after they had met skating that afternoon. (She still denies it to this day).

    Once the conversation starts to flow, it’s important discus other areas. Things such as, “ Have you thought about what you want to do if one of you becomes sick? Do you want to stay in the house? Who do you want to take care of you? You might mention what happened in other families when these issues were not discussed. The crisis and confusion that followed.

    I’d suggest that you then share with them, a very valuable three page form, “Five Wishes”, a well organized and sensitive questionnaire that gives them the opportunity to write down their health care preferences in many different situations. It can be found at www.agingwithdignity.org. Don’t try to have them fill it out then. Leave it with them and check in with them at another time to discuss their answers. You can also read my book, “Can We Talk?” where I have a created a series of more that 20 forms to gather important information from your parents. You can find it at www.parentcareplanning.com

    When do elderly people lose their youth?

    Guest post is written by Alana Vial

    Many of us direct our intentions to ensure that we enjoy a convenient stress-free healthy elderly life.

    But when do elderly people really lose their youth and begin to fall prey to the psychological and emotional burdens of the elderly stages of life?

    Factors That Make Elderly People Lose Their Youth

    There are 3 great factors that influence the loss of one’s youth:

    1. Stress – No matter how old one becomes or how young one still is, the amount of stress greatly affects his or her ability to deal with aging. The human body experiences increased aging due to the hormones that need to be released in a stressful environment. When such processes are repeatedly experienced, the human body can no longer undergo reversible conditions thus fall prey to aging.
    2. Support and coping – No matter how great the stress that elderly people experience, as long as they have the right coping mechanisms and support sources, they will stay healthy.
    3. Information – When it comes to maintaining one’s youth, the amount of information that has been acquired to deal with all possible problems of aging matters a lot. This involves gathering as much information as possible in not only dealing with the common diseases and problems of elderly life but also maintaining quality of life despite old age.

    When do you say goodbye to your youth?

    After everything that has been said, you can easily tell when an elderly loses his or her youth. It is the point the he or she gives up and loses hope. Seeing the world through the eyes of youthfulness is seeing it with strength, hope, and glee. No matter how harsh, depressing, or hopeless a situation, with all 3 factors mentioned above adequately provided to your elderly, they will never lose their youth and fall prey to the a disastrous aging process.

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    PERMISSION TO REPRINT:
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    Financial Advisors may reprint any articles from The Gift of Communication Blog in your own print or electronic newsletter. But please include the following paragraph:

    Reprinted from Bob Mauterstock’s The Gift of Communication Blog. Subscribe at http://www.GiftofCommunication.com  and receive Bob’s Family Meeting Checklist Guide.