The information in this column is not intended as legal advice but to provide a general understanding of the law. Any readers with a legal problem, including those whose questions are addressed here, should consult an attorney for advice on their circumstances.
Just bringing up the possibility of someone in your family becoming mentally or physically incapacitated is often difficult. We tend to think of only the very elderly needing long-term, hands-on care. Still, a recent report by the Alzheimer’s Association found that one in nine Americans age 65 or older currently has Alzheimer’s. With the baby boom generation aging and people living longer, that number may nearly triple by 2050. Dementia isn’t the only reason for long-term care, of course, but almost everyone knows someone already affected by it.
Waiting too long to plan can confuse a family about what the Mom or Dad would want, what options are available, and what resources can help pay for care. Rushed decisions are often the most costly. Having the courage to discuss the possibility of incapacity now can go a long way toward being prepared should that time come. By the way, because anyone can become incapacitated at any time due to illness or accident, the entire family would benefit from planning for every family member.
Care Options: Depending on the type and expected duration of care needed, options range from in-home care to adult daycare, assisted living facilities, and nursing homes. Health insurance generally does not cover assistance with activities of daily living (ADL), which include eating, bathing, and dressing. Professional care can be expensive; the national average for basic assisted living services is now about $52,000 per year. Care for those with dementia can last longer and cost more. Family caregivers, who provide the bulk of in-home care, are often unpaid, and the emotional and financial tolls can be considerable. Your discussions need to consider family finances and circumstances realistically.
Where will the money come from to pay these expenses? What resources will be available? Health insurance does not cover assisted living/nursing home facilities or help with ADLs. Medicare covers some in-home health care and a limited number of skilled nursing home care days, but not long-term care. Medicaid, which covers long-term care, was designed for the indigent; to qualify, the person’s assets must be spent to almost nothing. VA benefits for Aid & Attendance may be available for veterans and their spouses. If there are significant assets, you can self-insure and pay the costs. Home equity and retirement savings can also be a source of funds. Long-term health insurance may be an option if you want to protect these assets for your family. (Premiums are much lower when you are younger.)
Everyone over the age of 18 needs basic legal documents. These include an advance health directive or healthcare power of attorney (legally appointing another person to make healthcare decisions for you if you cannot make them yourself); a durable financial power of attorney (appointing lawfully another person to make financial decisions for you if you cannot make them yourself); and a trust and/or will.
Your parents may be harboring secret fears about what will happen to them if they need long-term care. Talking about this honestly, listening to their fears and desires, and putting a plan in place before it is required can help reassure them (and you). If you want to talk to your children, reassure them that you are just being realistic. Starting with a story about someone you know or an article you read can be a good way to break the ice.
Sam A. Moak is an attorney with the Huntsville law firm of Moak & Moak, P.C. He is licensed to practice in all fields of law by the Supreme Court of Texas, is a Member of the State Bar College, and is a member of the Real Estate, Probate and Trust Law Section of the State Bar of Texas. ©