How to Plan for Elder Care Part 3: Exploring Supports
This blog marks the halfway point for this How to Plan for Elder Care series.
In Part 2, we explored Identifying Resources. We considered how resources can be private- such as your savings, home equity, or purchased long-term care insurance - or public, including programs like Medicaid or Medicare, Veteran’s benefits, and Section 8 Housing. In Part 1, you learned the importance of building your “A-team” of professional advisors. Now, we explore supports that are or may become available to you. What do we mean by support? Mostly, we tell people or resources in your community that you can rely on when you need them. These supports may fulfill many different roles.
Exploring Supports
People who are aging may find themselves challenged to fulfill their daily needs. For example, consider a married couple, one with dementia, just getting to a doctor’s appointment. They may have to get up extra early to dress and prepare, coordinate transportation in advance, prepare questions and objectives for communicating with office staff, and take in complex information. In contrast, at the physician’s office, stop by the drug store and pick up additional supplies needed before returning home. It can be an all-day, exhausting endeavor. Having robust, pre-identified supports can mean managing in-home care successfully or moving to an assisted living community to plug into an existing support structure. Let’s talk in more detail about the types of supports that can be explored as part of elder care planning, including caregiving supports and emotional supports. Caregiving supports are crucial and may involve paid and unpaid or informal structures. Having a dedicated care coordinator also brings a well-developed plan for cohesive and aligned care. A reliable care plan provides space for you to pursue emotional support. Without a care coordinator and care plan, emotional support can be forgotten amidst the effort of getting through the day, nerves become frayed, and caregivers feel exhausted.
Informal Caregiving
Adult children, in-laws, adult grandchildren, or siblings commonly play an integral role in elder care planning. In fact, most care is provided by these informal, largely unpaid caregivers. Know who you can count on and for what kind of help or support, obtain a commitment from them and understand their limits or limitations. For example, if your adult daughter has school-age children, she may be pressed to take you a doctor appointment early mornings or mid-afternoon. Your other adult daughter may have an inflexible boss that requires advance notice to take paid time off to assist you.
Start by identifying your needs and then a corresponding person to talk to about helping fill those needs. Consider that the person needs to have time available, be trustworthy, and be willing to take on a responsibility that may start out relatively small but become much more demanding over time.
Families with several children may hash out a care schedule, each child offering their talent or niche skill: preparing meals, transportation and talking to doctors, or handling finances and legal matters.
Paid Caregiving with a Personal Services Contract or “Caregiver Agreement”
With a caregiver agreement in place, a parent can pay a child or relative or third party for the care or services provided. Typically, the parent is the employer and the relative is the employee. Wages are taxable to the worker just as in any employment situation. See an accountant to set up payroll properly. As long as the amount paid is reasonable, not in excess of what the parent would pay a third party to provide the service, Medicaid does not penalize the transaction or consider it a “gift.” But the agreement must be in writing and in place before caregiving occurs. Why pay someone to offer care when they are willing to help for free? Paying a relative to provide care can help preserve relationships, reduce feelings of guilt or resentment, and fairly offset for time away from work, school or other responsibilities, as well as time with family that is lost as a result of these additional responsibilities.
If you do not have children or family to assist, consider involving a personal services company. These businesses hire and train caregivers who can help with household chores, activities of daily living (such as bathing, toileting, or transferring), or transportation. The elder services industry has a lot of competition among personal services companies and they have various payment and pricing structures. It is common for the company to charge by the hour and to require a 4-hour minimum block of time for the caregiver, but there are companies that offer other arrangements. While these caregivers can help with many tasks, they are not licensed to administer or manage medications.
For higher-level decision making and money management, such as monthly bill paying, form a relationship with a trust professional in your community. Perhaps this is your accountant, a geriatric care manager, or an elder care attorney who is willing to serve as your fiduciary to make health care decisions or financial decisions, or both, for you. At Elder Law of East Tennessee, we offer fiduciary services for clients who lack natural supports who can serve as their agent under a Durable Power of Attorney or Durable Healthcare Power of Attorney.
Care Coordination
A care coordinator is a professional who works with you and your family to make decisions and arrangements to achieve your goal for receiving good care. These professionals are often a Licensed Clinical Social Worker (LCSW), Registered Nurse (RN) or Geriatric Care Manager (GCM). They have training and experience in aging, assessing capacity, handling cognitive decline or dementias, caregiving, and resources in the community that can offer solutions. A care coordinator does not become the decision-maker and does not take over all responsibilities of care giving. But your care coordinator does create a care plan for you and help you put it in place. That care plan contains your goals and how to reach them. The care coordinator actively participates in your decision-making process and helps locate people, services, or information that is needed or helpful in carrying out your care plan. The care coordinator also advocates for you and guides you and your family through the difficulties and unknowns. Our goal is to promote quality of life and to find the best care available and our care coordinator identifies the needs and wants and addresses them.Areas where a care coordinator is valuable:
To explain the complex care system
Protecting your spouse or partner from the difficulties of caregiving
To offer options and advice on difficult or complex and emotional topics
Helps end “decision fatigue” for caregivers striving to do their very best
Helps buffer resentment or frustration for caregivers who feel burdened by caregiving
To help select and instruct care personnel
For choosing and transitioning to a residential care community
To preserve your lifestyle choices
Arrange transportation and other necessary services
Coordinating care among medical professionals
Assist in using new technology, such as a personal emergency response service
When you are fearful of making a wrong decision
When you need a back up plan for your current primary caregiver
Planning in advance for challenges to come
Understanding Medicare, hospice, and home health therapies
Preserving self-determination in your lifestyle
Arranging a “going home plan” if you have been hospitalized
Making sense of long-term care insurance and filing claims
To educate you about the care system, its offerings and limitations
Helping you communicate with your family or friends
Staying connected to people you care about or your church or community
Preserving your mobility
Emotional Support
Getting older can be accompanied by feeling more vulnerable. Maybe you are becoming forgetful, have less energy, don’t see or hear as well, your balance is wobbly, or your driving feels daunting. Health often declines and limits your ability to be out at social functions, church, or interacting with friends, leading to social isolation. Perhaps your long-term marriage has ended with the death of your spouse. Now you have a void in your life, a deep loneliness, and overwhelming grief. Getting older is extremely difficult, perhaps one of the most challenging of life’s stages. Here are some suggestions for finding emotional support:
Explore counseling. Medicare covers talk therapy, so find a provider that accepts Medicare and your supplement or Advantage plan and invest yourself in exploring your situation and your feelings. Therapy can offer a safe space for coping with life challenges.
Locate a support group and participate. Support groups exist to address all kinds of needs, from the loss of a loved one to coping with dementia. Ask your “A-team” for help locating a support group that would fit your needs well. They are often hosted through neurology clinics, churches, senior centers, or other community groups. If you are comfortable with technology, or if someone can assist you with tech, there are online support groups to explore as well. Explore Walking with Joy, a Knoxville-based grief recovery organization, or locate a certified specialist through the Grief Recovery Institute.
Talk to your family or friends. Can you be vulnerable with someone you love and ask for emotional support? Share with them your feelings, concerns, and fears. A sensitive listener can offer understanding and empathy and help ease some loneliness. The people in your life seem very busy, and it can be hard to get their attention to talk about serious matters, so choose your time and place to cultivate the best possible outcome.
Snuggle your pet. An appropriate pet can offer a senior a multitude of emotional support and social interaction and address feelings of distress and loneliness. Feeling a solid attachment to a pet can lead to decreased symptoms of depression and loneliness in older adults.
Learn more about exploring your support from our intake coordinator. It’s a free call. (865) 951-2410.
