I hold power of attorney for my mother. She's 89 years old and for the last two years, she has had a close companionship with "Stanley," a widower in the retirement community she lives in. Lately when we've discussed her future care needs, Stanley has been present and has bristled at the idea of Mom moving into assisted living or skilled care, even suggesting she move in with him. I'm concened that Stanley could talk her into removing me as power of attorney and naming himself. If so, what can I do to protect her?
First, your mother’s happiness is undoubtedly important, but so too is ensuring that her interests are protected as she navigates this vulnerable time in her life.
So, take a deep breath. This is a common concern that many family members face, and you’re not alone in dealing with these situations that involve both touchy and practical issues.
I'm confused. My 78 year old dad recently had heart surgery and was released to a long term care facility for several weeks of rehab. He has Medicare and has a Medigap policy as well, but a long term care expert recently told me that Medicare won't pay for long term care. We've yet to get a bill from the facility, but now I'm concerned he's going to have to pay for this out of his pocket. Can you clarify this please?
Sorting through health insurance details can sometimes feel like navigating a maze, especially when it comes to your dad’s recovery after heart surgery. If you’ve recently been told that Medicare won’t cover long-term care while he’s in a facility for rehabilitation, you’re certainly not alone in your confusion.
Medicare and Rehab Services
First off, let’s tackle the terminology. When we talk about long-term care, we often think of assistance provided in a nursing facility over an extended period. However, after a hospital stay, what your dad is receiving at that facility is actually classified as rehabilitationservices – not long-term care —and that’s where Medicare comes into play.
To qualify for Medicare coverage in a skilled nursing facility (SNF), your dad needs to meet a few key requirements:
Hospital Stay: He must have a qualifying hospital stay of at least three consecutive days. Two days just won’t cut it, nor does admittance “for observation.” It must be an actual admittance for treatmentin a hospital for at least three consecutive days!
Timely Admission: He needs to be admitted to a Medicare-certified skilled nursing facility within 30 days of being discharged from the hospital.
Type of Care: The services provided must primarily be skilled nursing care or rehabilitation therapy (think physical or occupational therapy).
Coverage Duration
Now that we’ve established that Medicare does indeed help with rehabilitation in a long-term care facility, let’s cover the specifics of what’s included:
Days 1-20: Medicare Part A kicks in and covers 100% of the costs in a Medicare-qualified rehab facility. It just so happens that many of these facilities are also nursing homes.
Days 21-100: From day 21 onward, there’s typically a daily copayment involved. For 2024, this amount is expected to be around $200 per day. Definitely something to factor into your budgeting.
Days 101 and Beyond: After the first 100 days, Medicare steps back and does not cover any costs. It’s all out-of-pocket!
Out-of-Pocket Costs and Medigap Magic
With the basics in mind, let’s get to the crucial part: out-of-pocket expenses. This is where your dad’s Medigap policy can really come to the rescue.
What is Medigap? A Medigap policy is basically supplemental insurance that covers some of the costs that traditional Medicare doesn’t. Most Medigap plans help cover the daily copayment that starts after day 20.
Plan F: Offers full coverage of those copayments after the 20th day.
Plan G: Generally covers the copayments but requires that annual Part B deductible to be paid first.
Plan N: This one can require some copayments for certain services, but it still provides significant coverage for the days beyond 20.
Taking a closer look at your dad’s specific Medigap plan will give you the clarity needed to manage these potential costs.
Tips for Managing Long-Term Care Costs
Communicate with the Facility: When that first bill rolls in, don’t hesitate to reach out for clarification. Ask them questions about what Medicare is covering to understand your father’s financial responsibilities better.
Review the Medigap Policy: Make sure you’re familiar with the details of your dad’s Medigap plan. Each plan can have different coverage options, so understanding what’s included can help avoid surprises down the line.
Explore Other Aid: If costs start feeling overwhelming, consider looking into additional resources, like Medicaid or veterans’ benefits, which may help cover expenses once Medicare and Medigap benefits have been exhausted.
Get Professional Guidance: If you find yourself feeling lost in the financial fog, consulting with a financial advisor who specializes in elder care can provide direction and peace of mind.
While it’s easy to mix up the terminology surrounding Medicare, particularly when dealing with rehabilitation services in a long-term care facility, the key takeaway is this: If your dad is eligible and receiving rehab services, Medicare can help cover those costs—at least for a while! Understanding how Medicare and Medigap work together will empower you to make informed decisions about your father’s care and manage any potential financial burden.
Remember, you’re not alone as you navigate this. It may feel complicated now, but with a bit of persistence and the right information, you’ll find your way through!
I live far away from my older parents and I have no siblings. They insist on staying in their home as they age and I am concerned about their being alone. I work in the tech industry and would like to know what new technologies are useful to help families care for their aging loved ones?
This is such a common situation nowadays. As our parents grow older, their desire to remain in the comfort and familiarity of their own homes is completely understandable. For those of us living far away without siblings to share in the responsibility, ensuring their safety and well-being can be challenging. Fortunately, advancements in technology, alongside traditional forms of support, offer innovative solutions to make caring for aging loved ones manageable from afar. As someone working in the tech industry, you’ll find these developments particularly meaningful as they offer peace of mind while fostering closer connections despite physical distance
Smart Home Devices
Smart home technology has become indispensable for seniors wishing to age in place independently. Devices like smart speakers with voice-activated assistants (such as Amazon Echo or Google Home) enable seniors to set medication reminders, manage schedules, and control home appliances effortlessly. Additionally, smart security systems, like Ring doorbells, allow older adults to monitor visitors at their doorstep without having to physically open the door, enhancing both safety and convenience.
Personal Emergency Response Systems (PERS)
PERS have advanced beyond simple panic buttons. Current systems offer features like fall detection, GPS tracking, and two-way communication. Products such as MobileHelp and Philips Lifeline ensure that seniors can summon help at any moment, providing reassurance to both them and their distant caregivers.
Telehealth and Remote Monitoring
Innovations in healthcare technology have transformed access to medical care for seniors. Telehealth platforms facilitate virtual doctor visits, significantly reducing the need for travel. Additionally, remote monitoring tools track vital signs, including heart rate and blood pressure, sharing real-time health data with medical professionals to ensure timely care and intervention.
Robotics and AI
The rise of robotics and artificial intelligence in elder care is an exciting development. Companion robots like ElliQ by Intuition Robotics and Pepper by Softbank Robotics are designed to engage with seniors, offering companionship, reminders, and health monitoring. Furthermore, AI-driven tools can analyze behavioral patterns, identifying changes that may signal health concerns before they become serious issues.
I hold a valid power of attorney for my mother, but when I tried to use it at her bank, the bank refused to recognize it. Why would the bank refuse to honor a valid legal document?
As a holder of a power of attorney (POA) for a loved one, it can be incredibly frustrating when a bank refuses to recognize this legal document. You may believe that you have the authority to act on your mother’s behalf, but banks sometimes take a cautious approach when it comes to powers of attorney. Let’s explore some common reasons banks might refuse to honor a valid POA and what you can do if you find yourself in this situation.
My elderly father is resistant to the idea of relinquishing control over his finances, but he's starting to show signs of cognitive decline. How can I delicately broach the subject of financial power of attorney without causing conflict?
First and foremost, know that you’re not alone in facing this challenge. Many families encounter similar hurdles as their loved ones age, and it’s perfectly natural to feel apprehensive about initiating such conversations. It can feel like tip-toeing through a minefield of emotions, especially when broaching the subject of financial power of attorney.
Approaching the topic with sensitivity and empathy is key. Start by creating a safe space for open dialogue, perhaps over a cup of coffee, during a walk, or other quiet moment together. Express your concerns from a place of love and genuine care for your father’s well-being without sounding patronizing. I would also avoid using any of the phrases below as they can sound manipulative, demeaning, or patronizing.
How NOT to start the conversation
“Dad, now that you have dementia, don’t you think you need help managing your affairs…”
“You know, it’s only a matter of time when you’re going to slip up and make a big mistake…”
“I’m only doing this for you…”
“You know, Mom would want you to do this…”
Good conversation starters
In my Financial Caregiver Academy Course, I dedicate two lessons to Working as a Family. In Part One, I outline Seven Conversation Starters that may help begin the conversation. However, it may not always be you or a sibling that is best for broaching the topic. Sometimes a trusted friend, spouse, or outside advisor can open the door to the conversation easier than the adult child.
When discussing the idea of financial power of attorney, emphasize the importance of maintaining his autonomy. Assure him that this step is not about taking away his independence but rather about ensuring his wishes are honored and his best interests are protected.
One thing you could mention is the use of a SpringingPower of Attorney – that is only upon the occurrence of a predefined event will the power “spring” into being. Usually the event is when two physicians known to the individual attest that he is no longer capable of managing his affairs. Until then, your dad would retain full control over his affairs.
It’s crucial to listen attentively to your father’s concerns and reservations without dismissing them. Acknowledge his fears and uncertainties, and validate his emotions. Reassure him that you’re there to support him every step of the way and that decisions will be made collaboratively, with his input and wishes guiding the process.
Depending on your father’s level of understanding and engagement, you may find it helpful to provide educational resources or involve a trusted third party, such as a financial planner or elder law attorney, in the discussion. These professionals can offer expert guidance tailored to your family’s unique circumstances and help navigate the legal and logistical aspects of establishing a financial power of attorney.
Remember, these conversations may not always unfold smoothly, and it’s okay to take things one step at a time. Be patient with yourself and your father as you navigate this journey together. By approaching the topic with empathy, respect, and a commitment to collaborative decision-making, you can help ensure that your father’s financial affairs are managed responsibly while preserving his dignity and autonomy.
Confidentiality is one of the hallmarks of the attorney-client relationship. Clients expect their attorney to uphold the confidential nature of their discussions, and attorneys must adhere to a strict code of conduct to protect the public they represent. But what happens if the attorney questions the capacity of their client?
Capacity can be a complex legal doctrine, but legal capacity is required by parties of a valid contract. Moreover, standards of capacity can also vary by they type of contract entered into as well as by different states in which the contract is governed. For example, capacity to create a valid Last Will and Testament requires the one creating the will to know the general nature of their possessions and who their legal heirs are. Another standard may be applied to a more complex legal transaction.
Attorney Mark C. Palmer, Chief Counsel at the Illinois Supreme Court Commission on Professionalism, addresses how attorneys can work with clients that are demonstrating cognitive decline. In his article, Diminished Capacity of a Client: How Should a Lawyer Respond? | Q&A, Palmer discusses three questions an attorney needs to consider:
How does a lawyer know if the client has diminished capacity?
How might this change how a lawyer represents a client?
What protective measures can the lawyer take while meeting ethical obligations?
If you have concerns about the capacity of your aging loved one to execute a valid legal contract, consult with a qualified legal professional, preferably a Certified Elder Law Attorney (CELA) as well as your loved one’s medical provider. It is these professionals’ responsibility to independently determine whether your loved ones have the required capacity to act in their best interests.
She offers four tips to help those working from home AND who now share space with spouses, children, and perhaps an aging parent.
Set your parents up for success by establishing routines and clear communication where possible.
Set boundaries both for them and yourself so that you can minimize or control the interruptions that shared work and home life will bring.
Overcommunicate your situation with co-workers and managers. Chances are, they are in similar positions or there will be other co-workers who are as eldercare comes out of hiding and into the mainstream.
Do not neglect your own self-care. Caregiver burnout was already a big deal even before COVID. For the working adult children of dependent parents, at least the office provided the odd respite from the chaos of home. Now that is gone for many, so self-care needs to be a priority.
For the full text of the article, see the link below.
Caregiver burnout is a state of physical, emotional and mental exhaustion. It may be accompanied by a change in attitude, from positive and caring to negative and unconcerned. Burnout can occur when caregivers don’t get the help they need, or if they try to do more than they are able, physically or financially. Many caregivers also feel guilty if they spend time on themselves rather than on their ill or elderly loved ones. Caregivers who are “burned out” may experience fatigue, stress, anxiety and depression.
What causes caregiver burnout?
Caregivers often are so busy caring for others that they tend to neglect their own emotional, physical and spiritual health. The demands on a caregiver’s body, mind and emotions can easily seem overwhelming, leading to fatigue, hopelessness and ultimately burnout. Other factors that can lead to caregiver burnout include:
Role confusion: Many people are confused when thrust into the role of caregiver. It can be difficult for a person to separate her role as caregiver from her role as spouse, lover, child, friend or another close relationship.
Unrealistic expectations: Many caregivers expect their involvement to have a positive effect on the health and happiness of the patient. This may be unrealistic for patients suffering from a progressive disease, such as Parkinson’s or Alzheimer’s.
Lack of control: Many caregivers become frustrated by a lack of money, resources and skills to effectively plan, manage and organize their loved one’s care.
Unreasonable demands: Some caregivers place unreasonable burdens upon themselves, in part because they see providing care as their exclusive responsibility. Some family members such as siblings, adult children or the patient himself/herself may place unreasonable demands on the caregiver. They also may disregard their own responsibilities and place burdens on the person identified as primary caregiver.
Other factors: Many caregivers cannot recognize when they are suffering burnout and eventually get to the point where they cannot function effectively. They may even become sick themselves.
What are the symptoms of caregiver burnout?
The symptoms of caregiver burnout are similar to the symptoms of stress and depression. They include:
Withdrawal from friends, family and other loved ones
Loss of interest in activities previously enjoyed
Feeling blue, irritable, hopeless and helpless
Changes in appetite, weight or both
Changes in sleep patterns
Getting sick more often
Feelings of wanting to hurt yourself or the person for whom you are caring
