Caught in the Middle

A growing number of individuals and couples are entering the ranks of the Sandwich Generation.  What they have in common is that they are “caught in the middle” between the competing needs and wants of their dependent children and aging parents.  In addition, they also need to consider and prepare for their own retirement years and potential long-term care needs.

For example, most members of the Sandwich Generation value higher education and feel compelled to provide that opportunity for their children.  Other “sandwichers” are pressed into service by providing financial resources to a divorcing adult child or helping raise a grandchild.  In addition, as life expectancy increases, their aging parents are likely to survive well into their 90’s and require monetary and caregiving assistance. (more…)

Resources to Help Those Caring for a Loved One at Home

care-at-homeIf you provide home-based care to a loved one, you are not alone. Millions of Americans provide unpaid family care every year.

Being a caregiver can be overwhelming, particularly if you are juggling other responsibilities, such as working or raising a family. Knowing where to turn for help can make a difference — both in the quality of care your loved one receives and in lessening the stress and responsibilities on you. (more…)

Can’t We Talk About Something More Pleasant? Cartoonist Roz Chast Takes on her Aging Parents

mom-son-planning-togetherI expected a book of cartoons to be laugh-out-loud funny. But I didn’t expect that a story told in sketches would also make me cringe at its honesty or break my heart.

In Can’t We Talk About Something More Pleasant?, Roz Chast bares the painful decisions adult children often have to make as their parents’ health declines. She offers an unsparing look at how she handles—and mishandles—their falls, forgetfulness, stubbornness, dementia, abhorrence of nursing homes and dependence. I know it sounds grim, but leave it to Chast, a longtime New Yorker cartoonist, to mine the humor in their decline and her efforts to help. (more…)

Role Reversal: When Children Should Talk to Parents About Money

retired-woman-with-piggy-bankAs Baby Boomers grow older — and presumably wiser about economic matters — more are finding themselves in a position of caretaker for elderly parents. Raising the topic of money with parents can be difficult. But with the right choice of words, timing, and tone, you can open the door to a meaningful conversation.

Select a Representative. An initial conversation about finances should be done one-on-one. Involving too many people can be overwhelming and appear threatening. If you have siblings, select one — perhaps the oldest, most financially knowledgeable, or one with whom your parent(s) may feel most comfortable — to lead the way. Remember, this is about your parent’s money, not about yours or your children’s.

Be Sensitive. To some extent, our financial lives influence how we view ourselves as independent human beings. For many, old age is a time of coping with a series of physical and emotional losses: hearing, eyesight, mobility, memory, as well as friendships. With any conversation about money, be sensitive to the fears and concerns your parents may harbor about their possible loss of control or independence. (more…)

How To Have ‘The Talk’ With Your Parents

Remember when Mom or Dad sat us preteens down for “the talk,” the one that made us all squirm with embarrassment?

Fast-forward about 30 years, and perhaps it’s time for another version of “the talk,” this one initiated by the adult children. This discussion might be even more uncomfortable because the subject is Mom and Dad’s financial health, physical health and mental health as they age.

Ryan Keller, an eldercare consultant for geriatric care services provider LivHOME, knows all about these conversations. She’s helped initiate and guide many of them. Ryan is an expert on geriatric care management and programs, services and information on eldercare in the Bay Area.

How do you begin a conversation with older parents about their financial resources and their wishes as they age?

I piggyback on what’s socially acceptable in our culture, which is estate planning. It tends to be OK to talk about your will, powers of attorney and an advanced medical directive. I’ll say, “This is an extension of your estate plan. Let’s put a roadmap together of what things might look like if you had an impairment and were somewhat limited but could still function in your home. Let’s put it down on paper.”

What are the parents’ concerns?

They want to be independent. And they don’t want to be a burden on anyone. I tell them, “Don’t burden you children to have to make a decision about when you should give up driving. Think now about what you want. Do you want an aide to drive you? A taxi? Your children?” When people are in control of their decisions, they feel their wishes are being respected.

The fear in most cases is people don’t want to end up in a nursing home, and I don’t blame them. So the question is, Where would you like to grow old? Is there anything you’ve seen that you’d like to avoid?

Try to have the conversation in a less aggressive way so there’s less resistance. You might say, “When you get older, what would you like that to look like?”

One conversation should wrap it all up, right?

Don’t try to cover every aspect in one day. Say, “We’re not here to make decisions but to share concerns and share love. We’re just here to have a conversation, and to build that trust before there are more serious conversations to have.”

Any suggestions on how to raise the sticky subject of assets?

I’d recommend bringing in some trusted advisors—the CPA, the financial advisor, the estate planner—to explain what funds are available for what time horizon. Knowledge is the key to making sound decisions.

It’s important for adult children to know that there are options at all levels, from private care to government programs that can help. Sometimes families can help. An adult child may move in with a parent, or a parent may move in with the family of one of their children.

But no one should assume that they will be compensated during the elder’s lifetime or after for providing care. By the time an adult child has to step in, the elder may not be able to change a power of attorney or make changes to a will. So communication between the adult children is as important as communication with the elder.

Who should be part of the conversation?

All family members, even if they’re many miles away. You can include them over the phone or by Skype. I’d also encourage families and the elders themselves to consult with a geriatric care manager—someone with a background in nursing or social work, for example—because they are familiar with the language of services and can help coach the family through aging issues such as dementia.

What does it cost to hire a geriatric care manager?

In the Bay Area, expect to pay between $80 to $135 an hour. Look for a manager who’s affiliated with the National Association of Professional Geriatric Care Managers. The association’s website has helpful information on the services a geriatric care manager can provide.

Long-Term Care: Realities and Planning Steps

Approximately 60% of Americans over the age of 65 will, at some point, require long-term care. This article offers tips to help finance the cost.

Fact #1: Approximately 60% of Americans over the age of 65 will, at some point, require long-term care.1 For this and other reasons, more people are considering long-term care insurance. Maybe you should too.

Fact #2: The average annual cost of a semi-private room in a nursing home is currently over $80,000 per year, with significant variations by state.2

Fact #3: Medicare doesn’t cover long-term nursing home expenses. Medicaid will pay the cost, but to qualify you’ll need to spend down your hard-earned assets.

For these and other reasons, more people are considering long-term care insurance. Maybe you should too. Here’s an introduction to long-term care coverage and issues you’ll want to think about.

The Name Game

First, let’s define long-term care insurance. It can be used by anyone who needs ongoing care due to a disability or chronic health problem. Services that are commonly covered include nursing, social, and rehabilitative services needed in the home or at a facility such as adult day care centers, assisted living establishments, and nursing homes.

Because neither health insurance nor Medicare pays for long-term care costs, many people will need to cover the costs themselves or purchase long-term care insurance. The younger you are, the less expensive the premiums may be. That’s why it’s important to begin thinking about the insurance long before you may need it.

Common Questions

You’ll need to evaluate the “what if” issues before you purchase something that you may not need to use for 30 or 40 years. Here’s a checklist of questions to help you make an informed decision when purchasing a long-term care insurance policy.

  • Is the issuing company licensed in your state and financially sound? Independent companies, such as Standard & Poor’s and A.M. Best Company rate insurance companies based on their fiscal health.
  • What kind of services (e.g., nursing home, assisted living, home health care, adult day care, or a combination) do you want covered?
  • How much does the policy pay per day for care in different settings, such as a nursing home or assisted living facility? There may be a maximum lifetime limit. If so, is it adequate for your anticipated needs?
  • When do you want benefits to kick in? Generally, the longer the waiting period, the lower the cost of a policy.
  • Is there an inflation rider so that benefits remain constant with rising health care costs?
  • Is there a guaranteed renewable clause, meaning the policy remains in force even if you become physically or mentally incapacitated?

Why not include your financial advisor on your long-term care planning team? Together you can tackle the issue of whether long-term care insurance makes sense for you.


1Source: U.S. Department of Health and Human Services, 2013.
2Source: Genworth Financial, Inc. and National Eldercare Referral Systems, LLC, Cost of Care Survey, 2013.

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