Elder care: Trading places with your parents
Michael Abramowitz

Someday mom and dad could become financially and emotionally dependent on you. Are you ready?

"The chronic problems of aging don't lend themselves to quick fixes," warns Norman Hannay, president of House Calls Homecare, a geriatric care management company in La Jolla, Calif. "You can't go into surgery for dementia. You can't reverse osteoporosis. It's very difficult to rehabilitate functional loss."

As the general population of America starts to gray and baby boomers begin to retire, children of aging parents find themselves in a difficult situation -- balancing their own lives while trying to provide care for the people who gave them life. Today, about 6.5 million people require some type of assistance -- either in the home or in a nursing facility -- and 22 million families are providing care for an older relative, according to the National Alliance for Caregiving.

A rock and a hard place

This assistance -- from placing a parent in a nursing facility to setting up home health care to taking over for the parent financially -- can easily become an enormous monetary and emotional strain on the entire family. Marriages can be destroyed and families can find themselves fighting over what exactly should be done and who should take action.

"You are conflicted because you want to take care of an aging parent, but it takes an emotional toll," explains Joyce Gioia, a certified management consultant and president of the Herman Group, in Greensboro, N.C. Gioia has witnessed first-hand the burden placed on her two daughters, who provide care for Gioia's ailing ex-husband. "It's a real strain for them to go there and be with him, because he doesn't want to get better. Their father doesn't want to take care of himself."

Erica Karp, a licensed clinical social worker for Northshore Eldercare Management Inc. in Northbrook, Ill., helps families cope with the strain of taking care of an aging parent.

"Often, I am hired by adult children, and often the family is in a crisis situation," she says. "The family is concerned because the older person has changed somehow."

When a family comes to Karp, she assesses the situation with both the family and the person in need. Karp then presents a recommended plan of care, and the family will either decide to follow her suggestions on their own or have Northshore take action. Charges for the initial consultation vary depending on the complexity of the situation, but averages out to about $350.

"Most people want to do what is best for the parent, but they are not sure what that is," she acknowledges.

Loraine Sailor, office manager for Children of Aging Parents, a nationwide support group based in Levittown, Pa., recommends working the parent into the decision-making process by presenting alternatives to the current situation. For example, if a parent needs help with daily chores such as eating and dressing, an aide can be brought into the home. Or if the parent suffers from loneliness, say from the death of a spouse, adult day care programs give the elderly the opportunity to be supported by others in similar situations, as well as a place to participate in activities that they gave up on long ago.

"When communicating with an older parent, don't treat them as children and talk down to them," Sailor recommends.

"Try and keep lines of communication open," advises Francine Lynch, director of programs for the Equitable Foundation in New York. "Without a good relationship, these issues become even more complicated. Take your time; if your parent doesn't respond to your suggestions, give it a rest and try again later."

If the parent suffers from Alzheimer's disease or dementia, the child must understand that they are not dealing with a rational thinking person.

"At all costs, don't argue with them," she explains. "Appease them. If the parent is confused, puts on their hat and says that they're going to the mall, say to them, 'OK, why don't we wait a few minutes, and I'll go with you?' The parent will agree and forget a few minutes later what they had in mind.

"Most people fear their parents hating them. But you have to show them tough love."

Preventing a financial crisis

Another fear that comes into play for families is affording the cost of eldercare. Many senior citizens on fixed incomes see their nest eggs dry up as they bear the brunt of the cost of caring for themselves. A 24-hour home health care worker will charge a rate of around $100 a day and nursing home costs can be devastating.

"The average length of time for a person in a nursing home to spend down their assets is less than one year," says House Calls' Hannay.

Once a person is down to the poverty level, the only option left is living off of Medicaid. But what steps can be taken now to prevent someone, even currently healthy parents, from winding-up in a Medicaid-supported situation, due to a debilitating medical condition?

"Simply make sure that your parents have long term care insurance," stresses Gioia.

Long term care insurance provides for the cost of a prolonged situation of need, whether it's in the home, a nursing home or assisted living facility. Hannay says that premiums range from $1,000 to $10,000 per year, depending on your age and pre-existing conditions. Look for a policy that provides coverage in the largest number of scenarios, including assistance in cooking, dressing and cleaning. Also, a good LTC policy offers a high payment for services.

"In California, it costs $80 a day to get a worker in the home," explains Hannay. "If the policy covers $40 a day, it doesn't do much good."

Search for a program that lasts for the length of time that coverage may be needed. Some plans are good for a policyholder's lifetime.

"Alzheimer's patients can live a long time," he warns.

If the person is unable to afford long term care, here are some other options, as suggested by the experts interviewed:

• Cashing in a life insurance policy while the parent is still living -- policies other than term insurance build up cash value, if a person wants to surrender the death benefit.

• If there is a lot of equity in a parent's home, a home equity loan or a reverse mortgage may be a way to supplement income. Reverse mortgages pay the recipient a monthly income for life based on the amount of equity built into the home. The parent is allowed to remain at home, and the bank sells the house after the owner dies. Reverse mortgages are available for people 65 and older and are not considered taxable income.

• If the financial situation is dire, the sale of the parent's home can pay for medical needs. Sales can be made legally within the family at fair-market value prices, thus allowing the parent to remain at home and not be forced into a nursing home or move-in-with-the-children situation.

• Contact your employer's benefit department to see what help may be available to you. For example, some companies are providing for eldercare in the workplace, says Hannay. Similar to onsite child care, an employee drops off the parent in an adult care facility located at their place of work. Meanwhile, American Express offers eldercare referral services to its employees as part of its "Work-Life Initiative."

• Finally, CAPS offers an excellent guide to dealing with eldercare called "The Equitable Foundation's Guide to Aging Parents and Common Sense." The booklet lists agencies to contact and advice on coping with situation. If you would like to order a copy, contact CAPS at (800) 227-7294.

-- Posted: April 30, 1999