Geriatric care managers like myself are often involved in care planning, which is crucial to an elder’s health, safety and happiness. Not only of their person but of their property. There is short and long term care planning. After I assess an elder, I design a Care Plan that includes both types of planning. Even though the big stuff like advance directives and securing financial protection are ultra important, they take time to set up. I usually make one most urgent referral at a time so as not to overwhelm everyone.
Below are my Top 10 Tips for How to Plan For an Elder’s Long Term Care.
Make sure they have an Advance Directive AD for Health Care (ADHC), Physician’s Orders for Life Sustaining Treatment (POLST), Will or other document that delineates their health care wishes. Ask them who their agents are (i.e. appointed decision makers) if you don’t know. Ensure the documents still reflect their wishes. Review all the documents to make sure they do not conflict each other or recommend updating or voiding documents that do to simplify into one document. See to it that the elder, decision makers, and doctors have copies.
Make sure a notary notarizes an ADHC after discussing care wishes with elder and decision makers if they need to be updated or created and the form requires such. Include new notary page if your state requires such. Review care wishes with caregiver regarding CPR or First Aid, and what to do in case of an emergency. Discuss care wishes with family and reconcile dissenting views on care if needed before executing.
Ask an elder if they have an Advance Directive for Finance. They will not usually know what this is. Ask them who helps them make financial decisions and if there is a trust, living will, or other document that states who can make financial decisions with or for them. This is a sensitive subject and the materials are confidential so the elder must sign Releases of Information (1st and 3rd party) and/or their responsible party if they are not making decisions any more.
Obtain a referral from a Geriatric Care Manager or Social Worker for an Elder Law Attorney who can execute or update this document and reconcile it against the ADHC for conflicts. Or create a Trust if one is needed. Circulate as needed to financial planners and banks, which require it to sign onto accounts to write checks on behalf of the elder. The caregiver should not view or access this document. It should be kept in a locked file in the home or adult child’s home with extra sets of keys kept at an adult child’s home. All inheritance is detailed in the Trust.
When you ask an elder about their financial docs, it opens up a financial conversation if you go about it right. They’ll offer statements like, I’m not worried about money but may complain about the cost of their medications. There is depression era cost consciousness and there are expensive medications that could be safely substituted with generics or supported by a better prescription plan with a doctor’s sign off. You have to do the research to get to the heart of what they are telling you. When you get there they will say: Yes. You get it. Finally, someone gets it.
Make sure an elder and their responsible party (i.e. adult child) are happy with their doctors. See if the elder will let you come to the next appointment to assess the quality of care for yourself if you haven’t been attending. Notice whether the doctor appears to be listening to the patient and honoring their wishes. Ask Geriatric Care Manager for referrals if needed.
Make sure an elder is getting the most of their managed health care plan. Offer to review it to see how they could get more out of it (i.e. benefits they may not be aware of, timing care for best coverage, reviewing Explanation of Benefits to make sure the billing is correct). Rank their care needs in order of importance in different care buckets (i.e. physical, mental, psychological, financial, legal, household) and calendar benefit timelines. As well as premium payment to avoid missed payments. Let them know you will help them make their healthcare insurance work for them. Then, get to work doing so.
Ask them whether they want a caregiver if they don’t have one, how often, desired tasks. Work with financial planner and home care company if able to plan for an elder’s Cost of Care. An elder needs to know how they will pay for their care over time to accept such. Refer to reverse mortgage specialists if necessary. Review facilities for them if desired. Get the accurate numbers both of you need to become less anxious about their future.
Ask an elder about their end of life wishes to plan for how they want to live out the rest of their lives. Do they want to stay at home? Do they want to go to a ‘home’ if they can no longer care for themselves? Home modifications needed to stay at home are accessible. They may desire everything from a family reunion to more visits from family and friends.
Ask an elder about their funeral plans. Offer to help write an obituary today for elders. Many elders are afraid to talk about this but when discussed, the obituary becomes more of a memoir that they are actively crafting that puts their life in focus. Ensure all after death arrangements so the elder knows they will be taken care of. Get support for all of this.
Taking the long view of an elder’s situation really helps support longer term care planning that often is delayed due to ongoing crises. It is hard to get a handle on your elder’s care when you are constantly chasing competing needs. The Care Plan focuses everyone’s efforts and provides grounding to the entire Care Team. Siblings often want different things for their parents and the elders often want something else altogether.
It can become chaotic given the skill set of the elder and how many people there are to coordinate. Care Planning also helps everyone celebrate goals as they are achieved on what can seem like an endless continuum of tasks. Eventually, once the groundwork is built, more quality time can be spent with the elder. It’s worth it for the elder and their family to be able to sleep at night and enjoy their limited time together. This is icing on the cake of receiving much better care.