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4 Rules to Prevent Problems for Your Aging Parent

What can happen when families don't make decisions together


Making sure our parents have enough money to live comfortably in retirement is a concern many of us have. But their nest egg isn’t the only thing to consider. When you’re crunching the numbers, you should also be building a plan for decision-making in case a parent becomes physically or mentally incapacitated and his or her ability to make good decisions is compromised.

These decisions aren’t just about legal matters (such as a will) but also about medical decisions (such as a do-not-resuscitate order) and finances. Having a comprehensive plan in place will bring parents and adult children peace of mind. It’ll also mean that important decisions will have already been communicated to relevant family members if there’s an acute event like a stroke or a more gradual incapacitation, such as dementia.

If you aren’t prepared, you’ll face a mountain of questions with no way to answer them: everything from where is the will (and is there a will?) to who should be the estate’s executor to whether the parent wants hospice care at home.

(MORE: Why Elder Care in America Isn’t Working)

The family of Bill Simmons (not his real name) found this out the hard way and his story offers four rules for the rest of us:

Bill started acting out as soon as his wife died. He began drinking too much. He made impulsive, high-impact decision including selling his house, giving away most of his furniture, buying a new car and driving around the United States by himself … for two years. His children finally convinced their dad to see a lawyer and have his will drawn up. When he did, Bill named his oldest son as executor, gave him power of attorney and mailed the paperwork to him — but without first discussing his son’s willingness to take on the role.

Rule 1: Sit down with your parent to learn his or her end-of-life preferences and who’ll be responsible to handle estate affairs. This way, there’ll be no surprises about the parent’s intentions or the roles the adult children will need to play in making decisions. If a child is picked to be the executor but doesn’t want the job, make sure the next choice is willing and able to carry out the responsibilities.

(MORE: Roz Chast’s Graphic Caregiving Memoir)
During these years, when Bill disappeared for months at a time without warning, he began on a cognitive decline and started plowing through his savings. Bill refused to discuss with his kids how much he’d spent or how much he had left. It was hard to tell whether his cognitive issues were due to alcoholism or early stages of Alzheimer’s disease. His children knew he needed care, but Bill didn’t want to go into assisted living and his kids weren’t sure he could afford it even if he did.

Rule 2: Agree on annual face-to-face updates on your parent’s health and finances. For health matters, make sure that checkups and screenings are performed at the right frequency. If there are chronic diseases, keep up with details on their progression. If there are spending issues, a tough budget plan is in order. Agree early on about the aging parent’s preferences and opinions regarding independent living, institutionalization and assisted death. Get it in writing. Agree on how long-term care would be paid for before the first bill arrives.
Twelve years after his wife died, Bill’s functioning declined precipitously. His son didn’t want to have his father involuntarily committed, nor did he want to leave him alone. For a while, the solution was to hire a caregiver. As Bill worsened, his son found an opening at a well-considered facility for Alzheimer’s patients. 

Rule 3: Expect your parent’s needs to change without notice. During the annual review, find out whether your parent has changed his or her mind about where, and how, to continue living. Even parents who initially fiercely resist moving into an assisted living facility may adjust happily when the situation warrants.
By now the eldest son, using his power of attorney, had taken over Bill’s finances. It was going to be a race to the finish between how long Bill lived and how long his money lasted. A family meeting was held: Some of the siblings could afford to contribute to their father’s support, some could not. There was a high level of blame, guilt, and struggling for power. With great difficulty, Bill’s kids finally acknowledged that a) they all wanted the best for their father; b) they were never going to agree completely on caregiving and c) the only way to proceed was to let the oldest brother execute his responsibilities. He agreed to consider the preferences of the other siblings and include them as often as possible in decision-making.

Rule 4: Agree as a family that everyone will receive updates about caregiving, but that one person will be in charge. The siblings reconciled to their roles. Bill’s children who could afford to contribute money did so and they all built a plan for rotation of visits, focusing on birthdays and holidays. Two years later, Bill was diagnosed with advanced lung cancer. He declined treatment — which his children knew was his preference — and died in his sleep.

There are no happy endings to stories like this. But with thoughtful planning, regular communication and periodic re-confirmation of roles, problems can be contained and the parent’s quality of live can be maintained.

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