CHAPTER 11
Caring for Your Older Parents
In the middle of December 2017, I noticed my mother sniffling during our daily phone calls. A week later she had a hacking cough. And by the time Christmas came and went, it was the full-blown flu and my stepfather, Bob, had it, too.
Now, the flu is worrisome enough in older people, but this was the flu season to end all flu seasons. Doctors were hospitalizing patients with regularity. There was a run on Tamiflu. But my mom and Bob have good doctors in Florida, where they live during the colder months. They also have a robust community of friends and family—it seems like most of their Philadelphia neighborhood makes the pilgrimage and that I’d get a call if I needed to be more concerned.
Then a close friend of theirs died suddenly and unexpectedly. Their whole Florida gang packed up to attend the Philadelphia funeral—except for my mom and Bob. The doctor said they were too sick to travel and though Bob was rallying, my mom sounded worse. I had already started mulling the options—get on a plane, bring in a nurse, talk to the doctor about having her admitted—when my phone started to ring.
Did I mention I have brothers?
There are the two younger ones—who, despite being fully grown, highly capable men and fathers, I will always refer to as my “middle” brother and my “little” brother. Since my father passed away and my mom married Bob, I also have three fully grown, very capable stepbrothers, one of whom is a doctor in LA. (If you are ever lucky enough to acquire stepsiblings in later life, I highly recommend that one be a doctor.)
Anyway, the point is: they all called me. They may have defaulted to me because my mother (as opposed to their father) was the sicker one. But they could have also just gone along with my brothers, who have done it their whole lives—because I am the oldest and the only girl. In my family, it has always been understood that I am the one.
Which is not to say that anyone was shirking responsibility. Every single one of us was willing to get on a plane to Florida—and said so. In fact, one of Bob’s sons had the first boots on the ground. But it was also clear that I was the coordinator of care. I found the nurse who would check in on them twice a day through the long New Year’s Eve weekend. I figured out grocery delivery via Instacart.
This was the first time I felt like a caregiver for my parents. Although my father was sick for five years before he died, my mother was fully in charge. And even though I am one of those women who is a natural problem solver, it was daunting. It was daunting to wonder if I was doing enough—or too much. Daunting to try to manage from 1,300 miles away. Daunting to spend the hours on the phone with those five men who were, quite clearly, just as scared as I was.
There is more of this to come—for me and for most of you. As our parents get older—even if what you’re dealing with is a case of the flu that vanishes by February (whew!)—we need to understand that this is what lies ahead. And the sooner we can embrace it, and start planning for it, the better. Because we are all daughters, and daughters are the ones.
THE PROFILE OF A CAREGIVER
Caregivers are a huge and growing lot. More than 34 million Americans provide unpaid care for a family member or friend over age 50, according to AARP and the National Alliance for Caregiving. The average caregiver is a 49-or 50-year-old woman, typically working, with children of her own, who also spends twenty to twenty-five hours a week caring for other (female) relatives. Some are older. But many are also younger; nearly 10 million millennials are caregivers for parents and grandparents.
What do caregivers do? Only everything. Caregiving can involve a huge range of health-related tasks, and helping with what the insurance industry calls “activities of daily living”—bathing, feeding, dressing, grooming, toileting (yes, that’s a word). But most caregivers also do day-to-day errands, housework, and home repairs and take on financial tasks like paying bills.
And the cost of this care is staggering. The estimated dollar value of the informal care that family and friends provide is $522 billion a year—more than total Medicaid spending. The average cost to each individual female family caregiver? Nearly $325,000 in lost wages, pensions, and Social Security, according to MetLife—not counting the $7,000 that seven out of ten caregivers spend annually out of their own pockets to cover other costs.
But those are just the statistics.
What gerontologist Mary Jo Saavedra sees in her practice is more of a dance. When women like us become the caregivers, the overarching characteristic is a determination to do the right thing. Every day she meets with women who are smart, savvy, educated, and ready to go into full swing to protect their parents and take care of them when they need it. That can be tough on the often equally competent, problem-solving mothers and fathers who raised us. “There’s a natural tension that exists between children and their parents,” says Saavedra, author of Eldercare 101. An adult who has always been the parent has no intention of giving up their decision-making power. It can be a threat to them, and they’re going to fight it. “Meeting in the middle is where we want to find the magic,” she says.
The only way to do that is to plan for it. Accept a) the fact that longer life spans mean caregiving is something you’ll likely deal with at some point and b) the possibility that the costs may be large. “Really plan and budget for this, because it can be as big or as large as mortgage and rent now,” Care.com CEO Sheila Marcelo said on the HerMoney podcast. “If you’re not planning ahead, then it can really impact your career.” And your life.
START THE CONVERSATION
“My mom is my best friend, so I talk to her about money,” says Tracey, 30s, an attorney with two kids from New York. “I know that they’ve invested in long-term care insurance. I have a pretty good idea of their financial situation. And I think my brother knows a little bit more about their end-of-life plans.”
Tracey is unusual. Not so much the best friend part. Since Gilmore Girls hit the small screen in 2000, we’re hearing more Lorelai-and-Rory scenarios than ever. The talking about money part, though, is not happening nearly enough.
According to a 2016 study from Fidelity Investments (which surveyed both parents and their actual adult children), two-thirds of families disagree about when it’s appropriate to tee up a discussion about parental finances, and more than one-third say it shouldn’t be discussed until after retirement and until after health or finances become an issue. That is way too late, but Mary Jo Saavedra understands why it’s happening. “It’s never too early, but it always—100 percent of the time—feels like it’s too early,” she says. Perhaps that’s why:
• While 69 percent of parents say they’ve had detailed discussions with their adult kids about wills and estate planning… 52 percent of children say they haven’t.
• While 72 percent of parents expect that one of their adult children will step into the role of long-term caregiver if need be… 40 percent of the adult children identified as being that caregiver weren’t aware of it.
• While 69 percent of parents expect that one of their adult kids will be the one to help manage their finances and investments… 36 percent of those adult children didn’t know about it.
• And while 72 percent of adult children believe their parents should be tackling the issue of long-term care… just 41 percent actually are.
That disconnect is a big problem—for both generations. The problem with not having a full understanding of what’s coming your way as far as your parents’ needs are concerned is the toll it could take on your own financial security. Kathleen, 40s, a brand marketer in New York, is one of those in the dark. “I worry that my parents don’t have their act together as much as they should,” she says. “What would happen if they ended up depleting their savings and investments to pay for aging?” She has no idea what the answer to that question is, because they haven’t discussed it.
But here’s the thing. When we do start talking about it, almost everyone—93 percent of adult children and 95 percent of parents—feels significantly better.
So why are we so mute? Because it’s uncomfortable. It’s uncomfortable for parents because it requires facing their own mortality, acknowledging that perhaps they haven’t been as financially savvy as they might have liked, and letting their children into very private areas of their lives. It’s uncomfortable for adult children who don’t want to be seen as moneygrubbing, don’t want to insult their competent, independent parents, and don’t want to face their parents’ mortality, either.
You can understand why the messages that fly back and forth are as mixed as a batch of scrambled eggs. Research has shown that older parents want to maintain their autonomy and their independence—but also want their kids to be helpful and available. Parents are annoyed when their adult children try to help—but are also appreciative that they care enough to do it.
Put all of those reasons together, throw in some sibling rivalry, and you’ve got a massive roadblock on the way to having these conversations. The only way to smooth the path is to acknowledge the devastation that ensues if you don’t have them. If we wait to begin talking about these things until the need is acute, we may be too emotional to make rational decisions—and not have the time to properly research and think through our options.
Emily, 50s, a business travel consultant in Eastchester, New York, saw how stressful that can be as she watched her parents care for her grandmother. “She went from her home to assisted living to living with my parents,” she says. “Watching my parents decide when to dip into her disposable income had an impact on me. At what point do they hire someone to help? They waited until the last possible moment [to deal with all of it]. That was a huge lesson for me.”
Okay—you get it. So how do you get this conversation going?
First, pick a time.
It should not be in the middle of an event that has any other tension brewing around it. Thanksgiving, while you’re rushing around trying to make sure you have enough clean glasses to set the table? No. Two days before Thanksgiving, while you’re leisurely scrubbing carrots to make ahead? Much, much better.
Second, find an entrée, a reason to start talking.
Elder law attorney Carolyn Rosenblatt suggests big birthdays like 65 or marker events like retirement. “They’re very meaningful to the parents,” she says. “They signal a change—and that’s what the conversation needs to be about. The inevitable change of getting older.”
As a journalist, I’ve long been a fan of the give-a-little-to-get-a-little form of interviewing. You start with: “Mom, I’ve just started to look at life insurance,” or “Dad, I was going over my will.” Essentially you’re saying, It’s not about you, it’s about me. That should put them at ease immediately (they’ve been focused on you their whole lives). Reveal a few salient details, then say, “It made me realize we’ve never talked about your plans for the future,” or something along those lines. It doesn’t have to be perfect. It just has to be.
If you have nothing personal to fall back on, use the story of what happened to a friend or colleague—or bring up the news. Aretha Franklin, Prince, Michael Jackson, and author Stieg Larsson famously died without wills. Robin Williams’s family did battle over his estate. Mark and Priscilla Zuckerberg have pledged to donate 99 percent of their Facebook shares to charity. Three good conversation starters right there.
Third, cover the bases.
Among the questions to ask:
• What are your wishes for the future?
• Where do you want to live as you get older?
• Do you have a will/living trust/power of attorney/healthcare directives—and where would I find them?
• Who’s on your financial/health team—and could you make a list of how I could contact them if I need to?
• Where are your important documents?
• Where are your accounts—and could you make a list for me (including passwords) of how I could get into them if I need to?
• How are you doing financially?
• Do you have long-term care insurance?
Those are, essentially, the nuts and bolts. But these discussions also need to explore the what-ifs:
• What if you were no longer able to take physical care of yourself? Where would you want to live then?
• What if there were no longer two of you? Have you thought about where you might be most comfortable?
• What if someone started to notice that you’re slipping cognitively? Would you be willing to let us tell you about those concerns? And could we talk now about what you’d like to have happen next?
Fourth, keep the door open.
Ask: Can we talk about this again soon? In many respects, that last question is the most important one. You want to leave your parents with the impression that this is not one and done, rather this is something you’ll need to keep talking about as things change through the years. They should know you’re always ready for them to come to you, too.
What if you try—and get nowhere? Try invoking the 40/70 rule, which basically says that by the time adult kids are 40 or their parents are 70, they need to have at least started talking about these things. If that doesn’t do the trick, enlist the help of a professional (their lawyer, accountant, or financial advisor, not yours). Set up a three-way meeting and, while letting the professional lead, put as many of your questions on the table as possible.
SIBLINGS AND THE (QUESTIONABLE) FAMILY MEETING
A number of the professionals interviewed for this chapter invoked the importance of the family meeting, calling them a “critical piece” of the process. And yet, my mother hates them. Family meetings make her—and she believes many other people—feel ganged up on. It’s clear that everyone else has been talking, planning, scheming, in advance. She would rather talk one-on-one with each of her children and then—if necessary—come together as a group.
Either way works, but if you are a sibling, there is absolutely no question that your brothers or sisters should be involved in any conversation about care or assistance. Getting everyone on the same page early minimizes conflict later and makes it easier to move quickly into action when necessary. It also avoids suspicion. Sibling rivalries die hard, if at all. Brothers and sisters may wonder if you (or whoever is in charge) are trying to gain a financial advantage. They may speak out to your parent about how they don’t think your plans are the right plans, which can result in more stress on the one person you’re trying hardest to help: the parent.
Besides, as almost all primary caregivers eventually discover, help is a good thing. And figuring out what role everyone is willing and able to play early on—and getting buy-in for the plan—is a crucial part of that. It may be very clear what those roles are. I have a financial reporter friend with one sister who is a doctor and one sister who is a lawyer. In their family, it’s pretty easy to decide who handles the legal, the health, and the money. Usually the puzzle doesn’t present itself so clearly, and you have to just decide.
But there does need to be one point person who can interface with the doctors and who is (preferably) close enough to go to appointments, ask questions, talk to hired caregivers who are in the picture. Generally, this should be the same person who has power of attorney over healthcare. If no one in your family can fill this role, you can hire a professional called a geriatric care manager (more on this in a bit).
The important message here is that—even though it’s unpleasant—you have to do it. There may be disagreements and hurt feelings, but consider that dealing with them is like buying an insurance policy on the relationships with your siblings that will long outlive your parents. Or, as my dad used to invoke when the three of us were sniping at each other at the dinner table: Rule #537: You better have each other’s backs, because at the end of the day you only have each other.
USE ALL YOUR SENSES
The holidays—if they’re happening at Mom’s or Dad’s (or Mom and Dad’s)—are important for another reason, too. They give you a chance to see with your very own eyes how things are going. Which is why, if you haven’t been there for a while, you should arrange to visit.
Parents never stop being parents. Just as you downplay the sinus infection with the 101-degree fever you’ve had for a week to your kids as “just a cold,” many older parents don’t want to trouble you with their ailments. (That’s what lunch with their friends is for—or, as my stepfather calls it, “The Organ Recital.”) They may also be worried that if they do let you have a peek, you’ll start making moves to limit their independence.
Which is why you have to see—and smell, and touch (as in, how long has it been since this place has been dusted?)—for yourself. Don’t feel bad about this. “You’re not snooping,” says Jane Wolf Frances, a social worker and psychotherapist who runs the website Parenting Our Parents. “You’re acting like a responsible loving family [member] as you open the refrigerator. What’s in there? What’s missing? Look in the medicine chest. What are they taking? Who’s prescribing it? How old is it?” Look at the house itself. Are there grab bars in the bathtubs? Do they seem to be living downstairs and not heading up as much as they used to?
Look specifically for piles of paper in the house. By age 70, 10 percent of people start to lose some of their cognitive functioning ability. By age 80, half have some sort of cognitive impairment. Finances are one of the first areas in which this trouble becomes apparent. So, look for bills piling up. Are they opened? Does it look as if they haven’t been paid? Are there a lot of boxes, a signal that a lot of as-seen-on-TV or online shopping is happening? And are they hoarding cash? All are worrisome signs.
Finally, look at your parents themselves. How are they walking? Do they seem more frail than the last time you saw them? How is their mood? Their speech? Ask, point-blank, if they have fallen recently.
The last thing my stepbrother Gary (he would be the one with the dark sense of humor, also the doctor) says to our parents before he leaves is: Don’t fall. Older Americans fall around thirty million times a year—yet often don’t tell us about it because they think they’re buying their own one-way ticket to the nursing home. It’s true that falls are the number one cause of injuries in people over 65. It’s also true that many are preventable. Gary has vanquished every throw rug. And we’ve all got portable grab bars in our showers for when Mom and Bob visit. (They attach with suction cups and are less than $15 on Amazon.)
THE HIGH COST OF CARE
There’s no getting around it: Care costs. According to Genworth, the median national annual cost for adult day care is $18,200, assisted living is $45,000, a home health aide is $49,192, and a private room in a nursing home is $97,455. Depending on where you live, it can sometimes cost significantly more. And while Age Wave research tells us that 63 percent of people over age 50 do not believe they’ll need long-term care, 70 percent will.
So, while the starter question is “How are you doing financially?” or “How’s the money holding out?” you really need to get at these nuts and bolts:
• How much money is there?
• How much income is there?
• How quickly are they spending—i.e., after they receive their Social Security and pension checks, how much are they pulling out of their nest egg to cover the gap?
• How much equity do they have in their home, and is there a remaining mortgage?
• Do they have other debts?
• Do they have long-term care insurance?
This conversation may feel invasive to you and them (I feel like I’m invading my mom’s space just writing the questions—and she and I talk about it on a regular basis). Have it anyway. If you get one or two answers on the first go-round, take a break and try again in a week or so. Explain that you’re doing this as much for you as you are for them—which, by the way, is true. You need to understand as early as possible what the shortfall is so that you can plan for it, with your siblings, and still take care of your own financial lives.
Once you’ve got a sense of whether there’s a financial need, you can start planning for what you can contribute both physically and in dollars.
One mistake many family caregivers make is to measure the cost of care directly against their income. If the latter is equal or a little less, they quit to care for their parent. It’s often better for your long-term security to stay in the workforce, accruing retirement contributions and Social Security credits, and hire a professional caregiver—even if the current dollars are essentially a wash.
And pay attention to the cash flows as well. Age Wave notes that half of all caregivers don’t track what they’re spending. That’s a mistake from both a planning (you can’t control what you don’t measure) and a tax perspective. If it gets to the point where you are providing more than 50 percent of financial support for your parent (even if your parent doesn’t live with you), you may be able to claim them as a dependent on your taxes. You may also be eligible for the dependent care credit. And you may be able to write their medical expenses off as a deduction.
Should you purchase a long-term care policy for your parents as a way to hedge your bets? These policies are pricey. (The average cost for three years of care for a 60-year-old married couple is between $2,000 and $3,000 a year, and prices go up with age.) But if you, or you in combination with your siblings, can afford it, having a policy means not having to come up with the money to help later (or relying on benefits paid for by Medicaid, which are more limited than the services you have access to if you pay privately).
TAKING FINANCIAL CONTROL
There may come a time when your parents can no longer manage their money themselves. Cognitive impairment may not even be a factor. If your father always handled the money and he passes away, your mother may be at a loss for what to do. You can work with her (and perhaps a financial advisor) to bring her up to speed, or you can step in and assume some financial control.
You can also preemptively avoid some problems by putting as much as you can on autopilot. After my father passed away, I tried to get my mother to pay her bills online. She was cautious and disinterested. Then she started dating Bob (who is so fully automated he often functions as in-family tech support) and jumped in with both feet. The lesson I took from this is that just like our kids may be 1,000 times more comfortable with technology than we are, we are 1,000 times more comfortable with technology than our parents. Try enlisting their most tech-savvy peers to help them get with the program.
Then, establish a financial schedule so that things work in an orderly fashion. Schedule bills to be paid directly after Social Security or pension checks clear. If credit card, utility, and other bills aren’t on a convenient cycle, call the billers and ask to have this changed. If your parents want you in the loop, they can give you access so that you can monitor their accounts online and help pay the bills. Some billers will even notify you if your parents miss a payment.
Assuming your parents are okay with it, forge your own relationship with their advisors. Ask to sit in on meetings with the lawyer, accountant, and financial planner. If the plan is to use the house for money down the road, you may want the name of their real estate broker, too. Should there be a need for you to step in to a greater degree—or to assume financial control completely—you are getting into legal territory. Here are the steps to take.
• Let their advisors know what’s happening. The attorney who drew up the forms (more on this in a moment) will know you have power of attorney for finances, but the financial advisor and accountant should know as well.
• Put a letter of diminished capacity in place. This is an agreement between your parent and their advisor that allows the advisor to contact the person with power of attorney if they notice cognitive decline.
• Obtain online access to accounts. Even if your parents like to receive hard copies of their bills, almost all accounts have an online option now. Use your power of attorney to establish access to their bank, brokerage, credit card, utility, and other accounts so that you can monitor what’s happening if need be.
• Avoid joint accounts. Your parents may offer to put your name on their account as an alternative. Don’t do it. If one of you were to get into credit trouble, the other would be impacted. Also, after death, joint assets become the sole property of the remaining owner. If you’re one of a set of siblings, that could cause an inheritance squabble.
Finally, if you or your siblings are not in a position to do this yourselves, you can hire a daily money manager to pay bills, reconcile accounts, and keep your parents’ financial life running. You can find one through the American Association of Daily Money Managers at AADMM.com.
THE DOCUMENTS YOUR PARENTS (AND YOU) NEED
Fewer than half of American adults have a formal estate plan in place, according to LexisNexis. That’s a huge problem. If a parent or other older relative becomes ill or incapacitated unexpectedly, we may not have the legal authority to take care of the finances or—even worse—have a say in their care. What you’re trying to avoid is a messy guardianship or conservatorship proceeding in which you have to ask a court to allow you to assume control. It’s costly. It’s painful. And it’s avoidable. If, that is, your parents have had the following documents drawn up by an attorney (which, by the way, you should as well).
• Durable power of attorney for finances. This gives another person the ability to handle your finances on your behalf.
• Durable power of attorney for healthcare (a.k.a. a healthcare proxy or medical directive). This gives another person the ability to make health-related decisions on your behalf. A successor should be named for the person given both powers of attorney, just in case the first isn’t willing or able to do the job.
• Living will. This tells a doctor/hospital of your care wishes should you become ill or incapacitated, including wishes for life support.
• HIPAA consent form. HIPAA—the Health Information Portability and Accountability Act—is responsible for keeping your health information and your parents’ health information private. If your parents want you to have information about their care, they need to sign a form that allows the doctor to share it with you. The doctor’s office will have the forms.
A couple of notes about these forms. Different states sometimes require different ones. If your parents (or you) spend time in a couple of states, you’ll want to either make sure they have reciprocity or fill out forms for each one (if you do, make sure they’re consistent). The forms don’t do you any good unless someone knows they exist, either—so make a card to keep in your parents’ wallets (and yes, yours) that says they exist and whom to contact. Keep copies yourself and give copies to your siblings.
Finally, encourage your parents to put together a document that is essentially a road map to follow in case of emergency. My stepfather Bob calls this A Letter Of Instruction And Suggestion (because it can also include suggestions for how the parent hopes the child will proceed in involving siblings, caring for important causes, and otherwise living their lives). I’ve written one and I think you should, too. It includes the location of all the important documents (deeds, trusts, Social Security cards, birth certificates), passwords, names and phone numbers of institutions and important people to call, lists of accounts, insurance policies, safe deposit boxes, and anything else you think is truly important to running your life. Try to update it once a year.
TAKING CARE OF YOU
According to the National Alliance for Caregiving, nearly 40 percent of caregivers report high emotional stress from the demands they’re under. Many others, however, don’t even realize the toll stress is taking. The Mayo Clinic has identified nine signs of caregiver stress, among them losing or gaining weight, not getting enough sleep (seven to nine hours a night) or getting too much, becoming easily irritated, having physical symptoms (headaches, backaches, stomach issues), or finding yourself reaching too often for alcohol or painkillers to self-soothe.
It’s important to realize that where a long-term caregiving scenario is concerned, you need help. To quote Hillary Rodham Clinton: It takes a village. And, if you’re caring for a parent from a distance, a small country.
“Painful. Scary. Exhausting.” That’s how Lisa, 50s, a rabbi and mother of three from Chicago, describes the challenge of caring for her widowed mother from nearly 800 miles away. “Difficult to be far away and to not know what to do or what is right to do.” The distance is a big reason that Lisa and her younger sister (who also lives far away) made the decision to hire a geriatric care manager. The National Institute on Aging defines these people as “professional relatives.” Some are nurses, others are social workers, and still others have a certification as a geriatric care manager or Aging Life Care Professional from the National Academy of Certified Care Managers, Commission for Case Manager Certification, or the National Association of Social Workers. (Note: These certifications are important. Geriatric care managers are an unlicensed group in many states.) Geriatric care managers help map out a care plan and find the necessary specialists to help execute it. You can find one through the Aging Life Care Association at AgingLifeCare.org. Typically, you’ll pay $250 to $750 for an initial assessment from one of these folks, then an hourly rate of about $150 to $200.
Lisa describes hers as a “life saver.” She’s a crucial piece of the village Lisa has built—but she’s just one piece. Among the others she rattles off:
• The caregivers in her house
• The caregiving agency (which employs the caregivers)
• Mom’s closest friends, who show up ASAP at the house or, when needed, the ER
• Mom’s friends, who visit
• Lisa’s friends, who are additional eyes and who listen to and support her and show up when she is there and when she is not
• A cousin, who is local and there in an emergency
• A housekeeper of thirty-plus years, who shows up to cook, visit, and check in even when she is not working
• Medical professionals who will talk to Lisa and her sister
• A pharmacy that delivers
• The electrician, handyman, and plumber who can be counted on in a pinch
• And, of course, Lisa’s sister (“I couldn’t do this alone,” she says)
There is also a family friend who has, for years, advised Lisa’s parents on their investments. Every month, he reviews her mom’s finances, tweaks the investments if necessary, and—Lisa says, “tells [her] what to do.” The one thing Lisa is not worried about, thankfully, is money. Her parents saved and invested and made wise decisions. But that doesn’t mean managing the finances isn’t an arduous process. “When I visit, I review the bills she has paid, review her investments and bank account statements, and file her papers. I help her gather papers for her accountant. I work on her investments with our family friend. And I regularly explain to my mother what she has.”
There are a few ways Lisa is fortunate. Her mother still lives in the home—and the community—in which Lisa was raised. The doctors, lawyers, accountants, and other advisors are not strangers. If you don’t know the professionals—or neighbors—in your parent’s life, now is the time to introduce yourself to them. Do the same with housekeepers, dog walkers, or other regular service providers. And before you bring anyone who will be spending time with your parent into a home, check their references and into their background. Google their name and the keyword care or caregiver. Look for online reviews on sites like Care.com. If you have the resources, consider hiring someone from the National Association of Professional Background Screeners at napbs.com to conduct a check. And don’t stop there, Care.com’s Sheila Marcelo says. “I’m a big believer in auditing, surprise visits, checking in and making sure that this caregiver is a fit.” She’s also supportive of nanny cams—as long as you’re transparent with your caregiver—especially with dependents like seniors who you may know have dementia or Alzheimer’s and are not able to communicate regularly or well.
One final note about managing this village you’re building. Clarity is key. You need to be specific about what you need done, when you need it done, and—in many cases—how you want it done, says eldercare attorney Nicole Wipp. This is true of both professionals and friends who are pitching in. “We can’t expect people to read our minds or to know on a day-to-day basis what needs to be done, or what would help us the most personally,” she says. “If you don’t tell someone what you want them to do, they’re just going to come and do what they think you need; half the time it’s not what you wanted.”
AND A COMFORTABLE PLACE TO LIVE
The vast majority of baby boomers want to grow old exactly where they are rather than moving to a place specifically designed to help with aging. This is what we call aging in place. Your parents start out living independently but bring in caregivers and other helpers when needed.
What adult children want is often very different. “The natural inclination for an adult child is to immediately say that the parent should move closer to me so I can take care of them,” says gerontologist Mary Jo Saavedra. “The problem there—before you even get into housing—is that you’ve removed them from their social structure. Isolation is as deadly as smoking fifteen cigarettes a day or being obese. Having that connection and meaning in your life is very important to thrive as a human being.” And that’s not all. With all good intentions, you may have taken them away from their doctors, their activities, their routines.
So ask the questions: Where do you want to live? Do you have the resources to do it?
Answer 1: If they want to stay…
Look closely at their home to see if it needs to be physically altered. A 2014 report from Harvard’s Joint Center for Housing Studies cites five features a home must have to make it suitable for aging: A no-step entry, single-floor living, doorways that are thirty-six inches wide (with hallways forty-two inches wide to accommodate wheelchairs), accessible electrical switches and controls, and lever-style doors and faucet handles. Only 1 percent of the homes in the US have them all.
Getting them, of course, costs money. If your parents need money to renovate—or for other reasons—the idea of a reverse mortgage may come up. Reverse mortgages, which allow people to borrow the equity from their home while continuing to live there, are complicated and pricey. But there are some situations in which they work.
The interest rates on these loans are fixed (which is a good thing) and borrowers can access the money as a lump sum, in monthly increments (i.e., like a paycheck), or as a line of credit on which you pay interest only on the amount you borrow. This last option is the most attractive because it allows borrowers to use a reverse mortgage like a home equity line of credit you have just for emergencies. In years when stocks have tumbled and your parents don’t want to sell assets in their retirement portfolios (because they think they’ll eventually rebound), they can pull money from their home to live on instead. Then, when the markets do rebound, they can repay the reverse mortgage and go back to using money from retirement accounts.
The commercials tout that these loans don’t have to be repaid until the homeowner dies or is living elsewhere for at least a year. That’s true, but the downside to a reverse mortgage is that when money has been borrowed from the home, interest will accrue. That interest eats into the money your parents (or you) receive if and when the home is sold. They (or you) can walk away with zero. If they ever needed to move to an assisted living facility or nursing home, that cash would have come in handy.
Answer 2: If they want to go…
That puts more options on the plate. One is downsizing, or moving into a home better equipped to handle aging. Another is moving into a community specifically designed for aging, an assisted living or continuing care retirement community (CCRC). While some of these are basic, others have as many activities and amenities as a cruise ship. When adults move in, they typically live on their own. As they need additional care, they can move into assisted living, and eventually—if need be—into the nursing part of the facility, where care is available around the clock.
Dana, the solar power entrepreneur from California, explains that for many years her parents refused to even consider assisted living, then decided to explore CCRCs. And they fell head over heels. “They feel like they’re moving into a resort,” she says. “My dad can get his hair cut. There are lots of activities.” The price tag, however, is high. The financial application started with a credit check and a deep dive into the couple’s net worth. The contract Dana’s parents signed stipulates that they have to sell their home and that the CCRC has a first call on all of their assets. “We finally got it in writing that they don’t kick anyone out for running out of money,” Dana says. “But they don’t accept you unless they think it makes financial sense.”
That’s fairly typical. Entering a CCRC often entails a deposit (sometimes called a buy-in) of between $100,000 and $1 million, with an average of about $250,000. This money is the facility’s insurance against the care your parents might need in the future. Then there are monthly costs, which start at a few thousand and go up from there. All of this will be laid out in the contract you sign. Make sure a lawyer reads it before your parents—or anyone else in your family—sign.
And then there’s my mom, who has suggested she’d prefer to live with me and my husband rather than any sort of assisted living facility—a suggestion that is actually quite trendy. According to AARP, the number of parents moving in with their grown kids has spiked in recent years. There are many things to consider before you make a move like this, including space, whether your home will need to be renovated to work for your parent, and what sorts of services you’ll need to bring in so that you can continue to work (if that’s the plan). You may even decide, as we have, that maybe your parents shouldn’t move—but you should.
My husband and I have recently been exploring a move to Center City, Philadelphia, which is where my mom lives. As you might expect, my mother is worried about this. She is worried that I won’t have enough friends and that it will be too difficult for me to commute to New York City a couple of days a week for work. Mostly, she is horrified that this is all about her. It’s not. It’s about taxes. And property values. And proximity to the beach community we go to in the summer. And the fact that there’s lots of family nearby. But, yes, it’s about her, too. We’ll keep talking so that we can both get comfortable with that.
• Caregivers look a lot like you (today, or perhaps in the future). They’re women with careers and kids of their own who make room for what is essentially an additional full-time job: taking care of Mom and Dad. The goal is to do so without damaging your own financial future. If hiring a caregiver is equivalent to your salary, hire the caregiver so that you can maintain your income growth.
• We’re a lot more prepared to do this if we’ve had ongoing conversations about our parents’ existing resources so that we understand what we and our siblings need to provide, and then clearing the financial and legal hurdles that allow us to do it.
• As you care for your parents, don’t forget about yourself. You need the same wills, powers of attorney, and other documents as they do. And the right time to purchase long-term care insurance (if you’re going to buy it at all) is around age 50.
One of the big advantages of being a woman with money is that it gives us leeway not just to create a legacy for our children and families, but to make an impact on the world around us. Here’s how to think about that.
