Helping Families Navigate the Financial Challenges of Age Transitions

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Deciding which sibling deals with “nursing home stuff.”

Very few of us want to intrude in our parents’ lives. It is only when we begin to notice certain “things” about Mom and Dad that we begin to consider stepping in. Problems such as memory loss, dementia, diminished sight or hearing, or irrational investment or spending decisions, are signs it’s time to intervene.  Plus, none of us is immortal. As your parents reach their 80’s, it is time to make sure their financial house is in order.  My observation is that loved ones who are quick to provide care and support for their aging parents are often hesitant to get involved with Mom and Dad’s financial affairs. You just don’t stick your nose into other people’s business, especially your parents’ business. The aging parent often contributes to this reluctance. Opening up this part of their life is difficult; an admission that maybe they aren’t as sharp as they used to be.

Once you’ve made the decision to get more involved, several questions must be answered:

  1. What needs to be done? What is the appropriate level of care and/or type of living arrangement? The answer depends on both medical and financial considerations. Often this decision is made after consultation with your parent’s physician or a geriatric care manager.
  2. Who will be in charge? Unless you are an only child, in which case the answer is you, this task frequently falls to the sibling who lives closest to the area where your parent resides. Sometimes, you and your siblings will decide to share the responsibilities. In other instances, the sibling with special skills or aptitudes may be chosen. Sometimes, the job goes to the sibling who feels the most obligated. It’s a tough, emotionally draining job, so whoever is in charge will need lots of support.

For one Lansing, Michigan family, the adult children of local couple Ron and Lydia Barnes stated Monday that it was pretty clear which sibling would be handling all the nursing home stuff. “When the day comes, Sarah is obviously the one who will explain to Mom and Dad that it’s time for them to pack up and move into a retirement facility,” said Andy Barnes, 35, referring to his older sister, whom he identified as the one who calls the most often and has “even driven them to the rheumatologist once or twice.”

“It’s a Sarah thing, for sure. She can handle those things easily enough: finding the right place, signing them up, dropping them off, stopping by regularly, making sure the bill gets paid on time. I actually think she’d kind of like doing it.” Sources confirmed that Ron and Lydia are hoping for Sarah as well, since the prospect of depending on one of their other children for care “absolutely terrifies [them].”

Source: Pretty Obvious Which Sibling Going To Have To Deal With All The Nursing Home Stuff

Free Booklet on Understanding Annuities

Annuities were once simpler financial instruments than they are today. Issued by insurance companies, annuities offered savers a guaranteed interest that compounded tax free until the funds were needed at a later date. Now, they are highly complex financial instruments with a variety of features, interest options, charges, and penalties.

Many financial caregivers will discover that their parents own one or several annuity contracts and it will be incumbent on them to understand these complex financial contracts in order to best serve their parents in a fiduciary capacity. The flip-booklet below, Understanding Annuities, is one of several publications free to Wealth and Honor subscribers. It is written to help financial caregivers understand how annuities are structured, how they work, how they grow, and how they are taxed. Hopefully it will also foster a more constructive conversation with other professionals who are part of your team.

  • Immediate annuities
  • Deferred annuities
  • Index annuities
  • Variable annuities
  • How annuities are taxed and more.

Who is watching over the nursing home managing Mom’s Social Security?

According to the U.S. Government Accountability Office, nearly a million individuals relied on organizational payees to manage their Social Security benefits in 2018. Due to an aging population, more beneficiaries may need organizational payees in the future. These beneficiaries are among the most vulnerable because, in addition to being deemed incapable of managing their own benefits, they lack family or another responsible party to assume this responsibility.

The Social Security Administration (SSA) approves organizational payees—such as nursing homes or non-profits that manage the Social Security benefits of individuals unable to do so on their own—by assessing a range of suitability factors, such as whether the organizations have adequate staff to manage benefits for multiple individuals. However, GAO found that SSA’s policy does not specify how to assess more complex suitability factors, such as whether an organization demonstrates sound financial management.

Without clearer guidance, unqualified or ill-prepared organizational payees could be approved to manage benefits. Also, SSA does not currently require background checks for key employees of an organizational payee. In contrast, SSA requires background checks for individual payees—such as a relative or friend of the beneficiary. A comprehensive evaluation could help SSA determine whether and how to expand their use of background checks to organizational payees.

The GAO has made nine recommendations to the Social Security Administration to strengthen the protection for seniors whose benefits are being managed by an institution.

Source: U.S. GAO – Social Security Benefits: SSA Needs to Improve Oversight of Organizations that Manage Money for Vulnerable Beneficiaries

What the new “Patient-Driven Payment Model” could mean for Medicare nursing home care.

On October 1, 2019, the Centers for Medicare & Medicaid Services (CMS) began implementing a new payment system for Medicare-covered nursing home care. The payment system is called the “Patient Driven Payment Model” (PDPM). PDPM creates a new set of financial incentives for nursing homes to consider when admitting and discharging residents, as well as providing resident care.

According to the Long Term Care Community Coalition, some of the incentives created under the new payment model could result in less advantageous care for some Medicare-covered nursing home care.

Families with loved ones who may be eligible for Medicare-covered nursing home care need to educate themselves on how this new payment model could impact the quality of care their family member may receive after hospital discharge.

Joint Statement: The Patient Driven Payment Model What Does It Mean For Residents? – Nursing Home 411

To live longer, here are some steps you can take – The Washington Post

Today happens to be my birthday…and I’m spending it not writing this post, but trout fishing in Colorado, so happy 59th birthday to me! I will relish this last year of my fifth decade, but I’m also in denial that it’s all downhill from here. I intend to do all that I can to stay physically and mentally healthy for several more decades.

A recent article by Christie Aschwanden in the Washington Post outlines some simple rules for me – and hopefully others – to follow.

The rules are pretty simple — regular exercise most of all, healthy eating (and drinking), adequate sleep and staying socially engaged

Source: To live longer, here are some steps you can take – The Washington Post

Elderly hoarders must pay up or lose home. The Times – Apalachicola, FL

An elderly couple in Royal Palm Beach Florida has racked up over $400,000 of fines from citations received due to the deplorable condition of their home. 

Ralph and Marguerite McCormack, age 75 and 71, are reported to have dementia, have no children or close family, and suffer from a hoarding addiction.  Conditions were so bad at their home that investigators had to wear hazmat suits and gas masks just to enter their home.

The McCormack’s cleaned up their home in 2018 and want to sell it and use the proceeds to fund assisted living for both of them but at least one judge is taking a harsh stance,

“We are here at your mercy,” said attorney Jason Evans. “What happens now in this moment will affect them for their remaining days.”

But Doug MacGibbon, the special magistrate, denied the request. He said the hefty fines “are all self-inflicted wounds” from violations “that could have been cleaned up by” the McCormacks. 

The McCormacks filed an appeal Aug. 17 in Palm Beach County Circuit Court. Unless a judge overturns MacGibbon’s decision, the village can foreclose on the house.

“I can’t believe the village can be so vicious,” said Lisa Kline Goldstein, an attorney for the McCormacks, who specializes in elder law.

Source: $443,000 in fines: Elderly hoarders must pay up or lose home – News – The Times – Apalachicola, FL

Losing Your Mind, Losing Your Rights?

Kaitlyn C. Meeks recently published a Comment entitled, Losing Your Mind, Losing Your Rights?: A Certification Process to Safeguard Alzheimer’s Patients and the Moving Target of the Lucid Interval, 44 U. Dayton L. Rev. 79-109 (2018). Provided below is an introduction to the Comment. For the rest of the comment, see: Wills, Trusts & Estates Prof Blog

Picture this: you have awakened, on a seemingly normal day, to a drastic lifestyle change — the care of your mother or father. You, the child, have now become the parent. Why has this happened? One, or perhaps both, of your parents was recently diagnosed with Alzheimer’s disease (“AD”), rendering him or her incapable, in the eyes of the law, of maintaining complete and autonomous control over their life. The child is now the sole caretaker for the parent’s health, safety, finances, well-being, and legacy. As the new primary caretaker for an ailing parent, your life has become overwhelmed with legalities — Power of Attorney Forms, Health Care Directives, and Living Wills and Trusts. These stresses are in addition to the emotional effects as well as the financial and physical demands a caregiver is confronted with on a day-to-day basis.

Thanks to Gerry W. Beyer, Texas Tech Univ. School of Law for sharing.

4 Reasons Parents Don’t Discuss Money (and Why They Should)

Many adult children of aging parents find it difficult to talk to their parents about their finances. It is no wonder that these same adult children find it difficult to discuss their own wealth with their grown children.

Parents would be remiss if they did not talk to their children about drinking and driving, using drugs and, of course, sex. Some go even further, discussing subjects like bullying and mental health.

So why do a significant number of parents still not talk to their children about wealth and inheritance?

Nursing home has no standing in suit against resident’s daughter.

A New Jersey appeals court ruled that a nursing home has no standing to lodge a conversion claim or infringement of fiduciary duty against the daughter of a resident who transferred the resident’s cash to herself, resulting in a Medicaid penalty period.

M.D. is the daughter of B.S. In 2010, She started helping her mom financially. When she suspected that her mom’s husband had dementia and was spending her mom’s money “recklessly” she transferred money from a joint account into M.D.’s personal account. Over the next three years, she used some of the money transferred to provide care for her mom.

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A Conversation with My Older Me

They say that talking to yourself isn’t crazy as long as you’re not answering your own questions. Well reserve me a padded room because lately I’ve been having conversations with myself, and not just with myself, but with the 78-year-old version of me.  Okay, I can hear the footsteps of the men in white coats now.

But seriously, ever since I stumbled on this app that lets you peer into your future self, I’ve been engaged in discussions with my future self – who I call my “Older Me” – on how it feels to be old.  It is popular to ask what you might say to your younger self; what lessons you’ve learned and the mistakes you would encourage your younger you to avoid. On the other hand, I’ve rarely seen a discussion on what you would like to learn from the old you. Why is this so? Do we believe that we are at the pinnacle of our attainment of wisdom now, or as I hope not, do we think that the inevitable declines of aging make it unlikely that we will have anything of value to say to us today? Is “eat your fiber” or “slow down” the best we can expect? Furthermore, if we could sit with our old self, how might that change how we treat old people today. How might we honor them more, or treat them with greater dignity? We had better figure this out. National Geographic says there are now more people over age sixty-five than there are under five. Youth will inherit the earth and its governance.

I am currently 58 years old, old enough to be concerned about heart attacks and strokes (my father died at 41 of a heart attack) but too young to have gained much wisdom. By wisdom, I mean sage wisdom, calm, resolved, embracing life and embracing death wisdom. I’d like to think that in 20 years, I will have achieved what Swedish Gerontologist Lars Tornstam calls “gerotranscendence” which can be characterized as follows:

  • There is an increased feeling of affinity with past generations and a decreased interest in superfluous social interaction.
  • There is also often a feeling of cosmic awareness, and a redefinition of time, space, life and death.
  • The individual becomes less self-occupied and at the same time more selective in the choice of social and other activities.
  • The individual might also experience a decrease in interest in material things. Solitude becomes more attractive.

Has my Older Me become less self-occupied and more cosmically aware? I wanted to know. I’ve condensed my conversations into a Q&A style interview, and I’ve shared several snapshots of me and my Older Me for effect. Truthfully, it’s a little scary, like stepping into a time machine and finding yourself on some celestial fishing pier, with nary a care about anything you care so much about now, or even catching fish, just enjoying the sublime.

An Interview with Older Me


ME:        Well, first off this is pretty strange interviewing you since you’re me 20 years from now, but I appreciate you coming in today. Let me know if I need to speak louder or slower.

OM:       Okay, but I can hear you just fine, and I’m sure we’ll circle back to this whole assumption that all old people can’t hear thing.

ME:        Ahh, sorry. Not a good start. So, can you tell me how you feel?

OM:       Pretty good for an old you. Probably better than you feel right now on the inside, but I’m just a little slower and deliberate on the outside.

ME:        What do you mean “better than I feel right now on the inside?”

OM:       Remember, I am you, so I remember how I felt most of the time on the inside. You worry a lot don’t you? And you spend a lot of time trying to control people and things that you have absolutely no power to control. You wake up with your mind racing, and worry about money, about the kids, about impressing people, and…

ME:        Okay, okay…I got it. I’m happy to know you survived my worries. It seems everyone knows what they would tell their younger self. Are there any words of wisdom that you want to give me?

OM:       Well, the only thing I’ll say to you is that no matter what I tell you now, you won’t heed it so I won’t waste our breath. There are no short-cuts. Don’t you remember that preacher we heard years ago who defined wisdom as “the intelligent application of failure?” You haven’t failed enough yet. You have a lot more ahead of you. Sorry to disappoint you if you were looking for a simpler answer.

ME:        (laughing) So, no plugging into The Matrix and downloading the “wisdom” program?

OM:       The what?

ME:        The “Matrix”…Keanu Reeves…the blue pill? We loved that movie…Never mind.

ME:        Culturally, what is it like being old? Specifically, do you feel honored by society?

OM:       That’s much easier to answer for some of my cohorts than for myself. I don’t know that I’ve done many honorable things, but I have not done many dishonorable things either. Honor is a cultural value. A society – which is made up of individuals – should show honor towards all individuals and towards all positions that deserve honor, or that society will disintegrate. As to us old people, I do think the simple fact that we’ve lived this long and experienced more life than some others is a position that deserves honor. There are people I know who are now ninety-eight who are deserving of honor because of that. They can hardly go to the toilet by themselves but dammit they deserve to be honored, and frankly some of the behavior towards them by society or their families, or the medical and so-called “care” communities is appalling. I don’t really want to say anything more about that.  


I think I see the glint of a tear in my Older Me’s eye as he’s talking and I’m reminded of two poetic works: one is the song “Hello in There” by John Prine and the other is the poem “The little boy and the old man” by Shel Silverstein.

ME:        I want to ask you about death, because you’re closer to it than I am at 58 and I’m curious how you feel about dying?

OM:       Oh You think I’m closer to death than you because I’m older? Remember I’m just a figment of your imagination, so let’s face the fact that you could die today, or next week, or next year. Remember our father? You have no guarantees. But I will say this, what you have studied about is true; as I have aged, there is an opportunity to embrace ALL of life from beginning to end and to be at peace with where you are. Everyone your age is concerned about “bucket lists” and assume older folks have no zest for life because we take joy in simple pleasures and don’t want to climb Kilimanjaro or visit a lama herd in Peru. The truth is, most of us are just contented. When you’re younger, it’s hard to imagine having this attitude, and why it’s so much sadder when a young person dies. Time also changes. It passes faster for sure, but it also stands still – sort of like when the Millennium Falcon jumps into light speed and light itself slows down.

ME:        (Happy that I remembered that one!) So, it sounds like you’ve found some kind of peace with the end of life. Was this a spiritual thing?


OM:       I know where you are. I know you’ve lost faith in Something else beyond you. I know you are a logical cause-and-effect person who has difficulty reconciling the tragedies of life and the randomness of it with any sense of a larger purpose or Divine Mind. I won’t spoil it for you, but you do find your Myth. Call it God, The Universe, The Ultimate Cause, it doesn’t matter, but you do find it.

ME:        Ok, wow…Can I ask you how the kids are?

OM:       They were always OK. You know you can’t ask about the future.  

We break for a few minutes. I wasn’t expecting the conversation to be this heavy. I know I asked about dying and honor, and God and all, but I was hoping I still had my levity and a touch of irreverence. This was to come. I couldn’t help but wonder if I was taking this imaginary discussion too far. Technology – in the form of cheap photography apps – had allowed me to make the appearance of my Older Me all too real, but was this nothing more than an existential experience?

ME:        I was still hoping that you could share a few nuggets of wisdom, just two or three simple things.

OM:       Maybe I can offer a couple: First, you need to laugh more. Stop trying to be so self-respecting and flat out wheeze-laugh until you think that your heart is about to burst out of your chest. And so what if it does, at least you’ll die laughing.

And with that admonition, my Older Me holds out his index finger, smiles and says “pull my finger.” I’ll spare the details of what happened next but suffice it to say that we both enjoyed a belly laugh for several moments.


ME:        (wiping tears of laughter). What else?

OM:       Spend less time on that damn thing (pointing to my cell phone). Talk to people. All the surprise of life is taken away because people already know everything about everybody but nothing about anyone.

                Pick up the guitar again. You won’t ever be any good at it, but it might keep you from being so F-ing uptight. You’re so uptight I’ll bet you can whistle out your arse!

ME:        Right…(any doubt about my irreverence has now disappeared) Is there anything else before we wrap this interview up?

OM:       Yeah there is. Love more deeply. You’ve forgotten how but start practicing again. You won’t always have the ones closest to you and the only regret you may ever truly experience is knowing that they’re not around for you to love anymore.

And with that, the conversation ended, though hopefully not for good. Something tells me that my Older Me will visit me again, staying far enough in front of me so that I’ll never catch him, but close enough to recognize as a friend.

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