Within the past few months, my father-in-law had a stroke, and he and my mother-in-law were placed into an assisted living facility. It was a stressful time, with a lot of emotions involved — shock about the initial news, worry for his health, concern about an unknown future, stress about a million little details that needed immediate attention.
Through the course of several weeks, I tried my best to help my wife keep track of all those details to make sure nothing got forgotten. She had her brother to help with various tasks that needed to be accomplished, so I opted to stay out of the way and play a supporting role. Having never been through the process, neither one of us really knew what we were doing. Kinda like becoming parents for the first time. Luckily, my in-laws have settled in and appear to be adjusting well to their new life.
It sure was a process, though.
Here are a few things I learned along the way. Hopefully, this can serve as a resource for other folks going through the same ordeal. (Note: I also adapted several pieces of advice left by a commenter named Mark S. on one of my previous articles because they lined up so well with my experience.)
1. Don’t put off difficult decisions
You’re the adult now. It’s go time. Time to put on the big boy pants and get stuff done. Yes, we’re talking about your parents, and you will always be their baby. There’s a tendency to slip into those old roles because they’re familiar. The problem is, your parents need you now. Often, they’re not capable of making the difficult decisions due to health and age. They also tend to be set in their ways and unwilling to listen to advice — especially when they’re being told that they have to leave their home. It can be a traumatic realization for someone who has lived in their own home for decades. The longer you put off difficult discussions or decisions, the less likely you are to have them with someone in their rational state, especially if health problems are causing rapid deterioration. If you don’t make those tough choices now, your parents’ very quality of life could be put in jeopardy.
2. Never make a promise you can’t keep — like that you will never put your parents “in a home”
It’s tempting to make outlandish pledges, but if there’s no realistic option available, it’s actually more cruel to get your parents’ hopes up. Think about it. In order to keep your parents out of a home, you need a separate room, preferably on the first floor of your home; you may need to hire part-time or full-time nursing staff, depending on health conditions; you’ll have to buy and prepare extra food, which is challenging enough just for yourself at times; your parents will constantly be in your space; and you’ll need the budget to pay for all of this. That may be nice, but it can also be massively disrupting. Take the time to rationally consider whether you and your family can handle that.
Meanwhile, many assisted living facilities are far better equipped to handle the health challenges of the elderly, while providing daily activities and meal prep. Many of these facilities actually have head chefs that put together meal plans that are restaurant quality. In the case of my in-laws, their assisted living facility provides housekeeping, laundry facilities, religious services, exercise classes, shopping trips, a library, a business center with computer, printer, etc., physical therapy, and enhanced social opportunities to meet new friends. Look for a facility that doesn’t feel like an institution run by Nurse Ratched, and you might just improve their quality of life in the process.
3. Be ready for the expense of assisted living
Medicare does not pay for assisted living. If you can afford it, don’t look to cut corners and costs. All of the benefits I mentioned in #2 cost money. If you can start having those discussions with aging family members before a major health crisis, all the better. Have a frank and open conversation about what resources exist for paying for late in life medical and living expenses. Try to avoid the temptation of getting them Medicaid eligible so the expenses can be shifted to government funding. Too often, that leads to a lack of resources resulting in a reduced quality of life. As Mark S. noted, “Do you want your Dad to spend his last days in a shared room with a crazy alcoholic because that’s cheaper? It’s expensive, deal with it, plan for it, pay for it.”
4. Take steps now to secure the family’s finances so it doesn’t come back to haunt you
This is where the heavy lifting comes in. There are a million different bank accounts, credit cards, utility bills, and daily expenses. There’s probably a house. If it’s paid off, you have to decide what to do with it. One thing to remember is that if you do try to go the Medicaid route, there is a limited right of repayment for the expense of Medicaid out of their assets. That means that Medicaid could place a lien on the house or take other assets like bank accounts or other valuables out of the estate once they pass on. This article also notes that if Medicaid pays for assisted living, they have the right to attach assets from the heirs as far as 5 years after the transfer of assets to another name. So plan ahead, and absolutely move directly to step #5.
5. As the old saying goes, nobody ever lost money by consulting an attorney
Depending on what assets are on the line, you may have tax implications, asset protection issues, bank accounts to secure, and a whole host of other things you’ve never dealt with in your life. It makes sense to spend a few hundred dollars on an attorney to handle all these legal issues. You will need to secure a power of attorney to have your name put on all the accounts, set up automatic bill pay, transfer phone and cable to the assisted living facility (an unanticipated pain in the neck that cost us hours of effort), receive tax statements to assist with the paying of income and property taxes, and decide what to do with the home. Do you sell the home, transfer it into a trust, rent it out for income to pay for assisted living, or … ? You’ll have a ton of questions, and an experienced estate attorney can be a vital resource.
6. Get a medical power of attorney immediately, and take a proactive role
Speaking of legal advice, you absolutely want to secure not just a financial power of attorney, but a medical one as well. My family ended up not using an attorney to secure this, as a standard form (and a mobile notary public) were available at the hospital. However you secure it, this is your pathway to being directly involved with the medical professionals making decisions on your parents’ health. We found that while they were at home my in-laws were not always taking their medications as prescribed, and the assisted living facility needed to be informed so they could proactively encourage them to go down to the medical facility every day to take them. You will also find that when they’re asked about health details, they might leave out important details. It’s important that someone be there to make sure nothing slips through the cracks. Again, Mark S. notes that you must be prepared to step in if the care being provided deteriorates: “‘Do not resuscitate’ directives and living wills are not worth the paper they are written on. Use a medical power of attorney that appoints someone to make medical decisions if the grantor becomes incapacitated. The medical community will chase technology and heroic efforts rather than deal with quality of life. Docs prescribe opioids and ‘sleep aid’ drugs like Ambien like candy. It zones out old people and handing out addictive prescriptions is faster and easier than actually dealing with and diagnosing chronic pain issues.”
7. You’ll need help. Ask for it.
This process isn’t easy. It’s an unimaginable amount of stress, grief, work, and emotional fatigue. Take time for yourself to recharge. Be willing to ask for help. Often, you and your parents can get so frustrated dealing with each other through the process that you stop listening to each other. Allowing a new voice to step in — be it a family member, geriatric case manager, or a legal or financial professional to offer advice — will allow everybody to step back and regain perspective.
8. Know your role, and be ready to fulfill it
You are their advocate. You are also their partner. It’s your job to make their new lifestyle as normal as possible and as comfortable as possible. Transitioning into a new home is hard for everyone. There’s no need to be a dictator, but you are the person that is in the best position to help with difficult decisions and create as high a quality of life as possible. They need to be involved with as many of these decisions as they can handle, and you’re there to handle the stuff that they can’t.
9. Have empathy, but be firm
Your parents are facing their own mortality. This is a frightening time for everyone in the family. They may push back, which is why you should look for ways to make the conversations easier. Think about how you deal with your children. Do they like it when you lecture and raise your voice, or do they respond better to a conversational tone? Offer to help instead of telling them what they should be doing. Use examples from your life or your friends to start a conversation. Whatever you do, don’t give up and don’t stop trying. Eventually, your parents will adjust to the idea and become more receptive — hopefully while they’re still able to make solid planning decisions for their future.