Latest news with #AgingParents
Forbes
29-05-2025
- General
- Forbes
Who Is Taking Care Of Our Elders?
Many families face the task of figuring out how to get help at home for their aging loved ones. Typically, we at giving advice to families, see the daughter or daughter-in-law taking the lead on the effort. As no one teaches us how to do this in school, it is sometimes a daunting task to figure out what all the 'non-medical'agencies and other sources of help actually offer by way of home care workers. The word 'nurse' is used by the public to suggest that that is the caregiver they're looking for. But skilled nursing is expensive, and for long term care at home, Medicare does not pay for skilled nursing. Only licensed home health agencies offer skilled nursing, generally together with physical therapy, occupational and speech therapy. Short term help with skilled care is sometimes offered after a family member had a stroke, for example, and is being discharged from a hospital or 'rehab' facility, also called a skilled nursing facility. Once the patient has reached what they call 'maximum rehab potential' with these skilled services at home, Medicare cuts off payment and services end. This care may last a few weeks only. What is 'non-medical' care at home? Care at home Individual providers and home care agencies, which do not provide any skilled nursing or skilled therapies may offer a variety of worker types. They may be classified as follows: 1. Certified Nursing Assistants. These folks are trained to work in skilled nursing facilities if they choose to do so. They know how to take blood pressure and other vital signs and work in a team. Different states have different qualifications, but usually the CNA has at least a few weeks of training to become certified. 2. Certified Home Health Aides. Like CNAs, HHAs have specific training to work in the home setting, and expect to do so. Certification of any kinds sets this worker a little apart from any uncertified worker, because the training is specific and standardized in the state. 3. Dementia-trained home care workers. Caring for individuals with dementia can present specific challenges. Behavior may be difficult. Aggressive verbal or physical outbursts, wandering, sleeping during the day and being awake all night are some examples. Training for workers to manage dementia-related issues is not standardized. Typically, if an agency holds itself out as offering dementia trained workers, it will charge a higher hourly rate for this. One seeking this kind of worker needs to ask a lot of questions about the qualification and training of any worker offered. 4. Home care workers, general. This is the most common kind of help people hire for an elder at home. They assist with things we call 'activities of daily living' (ADLs), which means walking, bathing, toileting, dressing, eating and getting from bed to chair and back. Some workers took care of an elder in their own families and that is their only training. Others have had in person or online courses in home care. And some have little to no formal training. If you need to keep costs down, this level worker tends to be less expensive on an hourly basis compared with those certified or specially trained, but it does have risks. 5. Companion care workers. These are folks who do not help with ADLs but offer socialization, transportation, and may do cooking and shopping and other tasks with or for the person in need. This level of care is also available through many home care, non-medical agencies. It is a way to prevent social isolation. It's company, conversation and someone to take your elder to enjoyable events. You have to know what to ask for if this lower level of need is what your elder requires. It typically costs less than someone who assists an elder with ADLs. In summary, it can be daunting to figure out what the elder can afford, what kind of worker will be best and where to find the right person to assist your loved one. However, by giving a clear description of what your elder needs to those who offer services, and by asking the right questions, you can find a match. Prevent Pitfalls in Hiring It is critical that you or your elder hire right. For guidance on avoiding mistakes, see my book, Hiring A Home Care Worker: What Could Possibly Go Wrong? It draws on my years of being an RN who visited people at home all day and in training and supervising home care workers myself. You want to be able to understand the risks of having an unknown person with an elder, probably unsupervised, for many hours. If you are considering getting help for a family member with dementia, be particularly cautious about protecting the vulnerable person from abuse.
Forbes
09-05-2025
- General
- Forbes
Blended Families, Inheritance And Preventable Conflicts
With the U.S. divorce rate at about half of all marriages, blended families are a part of society's landscape. Many divorced parents do remarry and have to contend with working out the complexities of relationships among their children. Some siblings come from a prior marriage of one parent, others from the other parent's past. Some are the product of the second or third marriage. It gets complicated. What we see at where we consult with families, is that any underlying conflicts seem to surface when one or both parents age and need care. And these conflicts can be explosive after a parent or step-parent passes. Jealousy can rear its ugly head. And sad injustice can come out of it. Here's one real life example: Unfairness To The Caregiving Sibling Faithful Step-Daughter (FS) loved her step-dad who had always treated her with kindness and love. He was widowed and lived alone. As his health deteriorated, he needed care, part time at first and then full time as he grew more frail. FS quit her job, moved in to be the caregiver and dad was happy with this. Theirs was a good relationship to the end. He had dementia and needed a lot of help. FS had two step-sisters, from dad's first marriage. All got along well. FS lived closer to her dad and she assumed the role of primary caregiver. The sisters accepted this and did not question her, seemingly appreciative of her considerable work caring for their father. They participated very little in caregiving, leaving the responsibility to FS. There were no written agreements about caregiving. FS received support from dad in exchange for her work, as she did live with him, but no formal salary. The Conflict Woman getting bad news that she is evicted After dad passed, the truth of how the step-sisters veiwed FS surfaced. He had left most of his estate to his daughters by his first marriage. FS did not receive anything close to a proportionate share. Step-sisters decided to sell dad's home soon after he passed. They gave FS thirty days to move out, once the home was listed for sale. She had nowhere to go and did not have money to buy a place for herself. Unfair? Certainly! Were the step-sisters motivated by greed? That is unclear but something motivated them to ignore the work FS had done in making their dad's last two years safe and peaceful in his own home. FS thought they were jealous of her close relationship with their dad and this was their way of saying so. They would have had a choice to make things right for FS but did nothing. FS was crushed and terrified. Eventually she got a job as a paid caregiver, but she never had any financial security after that. Could This Unfair Result Have Been Prevented? We believe it could have been prevented by careful planning and legal documents. One thing FS needed to do at the outset, before quitting her job, was to ask dad to accommodate her with a gift in his estate plan, at least, or a written contract for her services, spelling out a fair payment plan. FS did not think about her future. Dad did not think about her future either. To be sure, the ask would have been uncomfortable but nothing like the uncomfortable realization that FS would potentially be left with so little after her caregiving role ended. As her step dad's dementia progressed, it was too late to ask him to make any consideration for her in his will and trust. Facing What We Don't Want To Face It is not just in blended families that we see conflicts about the sacrifices caregivers make for aging parents. But conflicts can be worsened when underlying emotions, never verbalized, emerge after the caregiving ends. For anyone who takes on the role of caregiver, particularly if you must quit a paid job to do this, be sure you are not blinded by your own loving sense of duty. The cost of paid caregiving is substantial and rising. According to the most recent Genworth Cost of Care Survey, the national annual median cost in 2024 for a full-time in-home caregiver was $77, 792. Doing the job for free is fine if you can afford it and you have a secure future afterwards. If not, it is best to communicate the value of what you propose doing to all concerned. Make a fair arrangement for yourself. Family Meetings What FS could have done before assuming the substantial role she planned to undertake was to speak to her step-dad privately about a plan for her as well as for him. Once that was agreed upon, dad could have called a family meeting to let everyone know what he wanted to do. That would likely have prevented the shock FS experienced after he died in being evicted, left with insufficient income and feeling the unfairness she felt. Her dad probably would not have wanted that but apparently, he never thought it through and neither did FS. Communication to all in the family about who is doing work is critical to avoiding bad outcomes and the injustice of caregiving without any recognition of its dollar value. The Takeaways 1. Talk it through If you or any sibling in your family, blended or not, is likely to take on a caregiving role, bring up the subject for discussion with aging parents. Their resources would be used to pay for care if no adult child could assist when the time came. Unspoken expectations about 'duty' need to be aired openly. 2. Compensating caregivers If you or your aging loved ones do not have the resources to meet the high cost of care in a supervised environment like assisted living or a nursing home, open the discussion in the family about a plan to fill that potential caregiving need. Family is typically the source of unpaid caregiving when the elder in need does not go to another living environment. How can the family make that fair to the one who would do the work? 3. Change the estate plan If the aging parents do not have high income, but their wealth in their paid for home, seek their consent to amend their estate plan to compensate a caregiving family member for the labor of caregiving after the elder passes. Then seek the advice of the parents' estate planning attorney or your own to ensure that consideration is provided, when possible, for the work the caregiver has done. The aging parents must be competent to change or add to a will and trust. Don't wait until they have cognitive impairment and could be found incapacitated to make such important decisions. Act at the first sign of physical/cognitive need for help.
Forbes
07-05-2025
- General
- Forbes
Secrets Of Successful Solo Agers
There are more older people living alone in the U.S. than you might think. As of the most recent U.S. Census Bureau data (2023 estimates), about 15.2 million people aged 65 and older live alone. That means about 1 in 4 seniors are living by themselves. Will you be one of them? Some of us have aging parents who live alone and some of us are the aging parents ourselves. From any vantage point, there are matters of concern. Some older people live out their senior years adapting well, but many others struggle. What's the difference between the ones who seem to do it fine and the ones who don't? It looks to be a matter of conscious planning, or some can call it 'facing your fears'. Solo ager Alice, at 93 Components of Success on the Solo Journey Here at where we offer consulting and strategy to those with aging loved ones, we see a variety of attitudes in the older folks. Some seem to pretend that they will always be just fine, no matter what age they are, regardless of many physical warning signs that they are no longer just fine. Denial does not produce good planning. On the other hand, we see very wise elders who recognize that they have to look out for their own aging process and potential decline in health and be sure protections are in place. They don't want to leave a mess behind them. Those are the ones who completed their estate planning documents in a younger day, appointed someone to be there in an emergency, made sure they had active connections in their communities, and avoided becoming isolated in less than ideal living situations. Examples of Smart Planning For Solo Aging Retired Teacher (RT) was a healthy, active person, living with her husband in the same house for decades. She had no adult kids in the area. She knew her husband had a few health issues, though he was generally okay. She decided it would be best if they gave up their comfortable home and moved into a local seniors' community. He resisted. She took the long view. She didn't want either of them to struggle without the other, all alone. They did move. Three months later, her husband fell ill and passed quickly. RT was already in a community. She felt safe. She was involved in it and stayed there for life. As her own health deteriorated, she had all the care she needed at hand. Hers was a successful journey alone in her last years. The oldest woman on record in her county (OW) lost her husband and decided to remain in her own house after that. She never had children. She made a community of friends and others and engaged with them daily. She kept very healthy habits, ate a clean diet, exercised every day and intentionally chose not to sit home alone in front of a TV. She remained busy for life until her very short last illness. She lived to be 113. Keys to her success were her physically active lifestyle and her intentional, association with others daily. Active Elder (AE) is 80, widowed and lives alone in a suburban condo. She sold her large home after becoming a widow. 'Too much to maintain' she says. She has no family in her area. She is involved in her local Rotary, and participates in every social event they conduct as well as attending weekly club meetings. Their motto is 'service before self'. She has a sense of purpose in that part of her life. She loves to travel and plans trips to interesting cities. Her habit is to rent a house for a month and invite friends to come visit and experience the city with her. She enjoys hosting guests and finds the travel exciting and fun, exploring different cultures. Traps Solo Agers Can Fall Into-What To Avoid The most impactful life event may be losing a partner or spouse. This is unquestionably devastating and can leave the survivor feeling totally lost in life. It may feel like the path of least resistance to withdraw and do nothing. Staying home, being depressed, and getting stuck in that place leads to no good outcome. A newly solo older person has to do hard work to survive and find a new path to a fulfilling existence. Getting help to process grief, accepting help from others and creating ways to adapt to the profound change in one's daily existence are essential. What Doesn't Work Childless Woman (CW) lost her husband quickly after a stunning diagnosis. She felt as if her world had ended. Even after a couple of months, she did not respond to friends trying to spend time to comfort her. She rejected every kind suggestion her small circle of friends offered. She got progressively more and more depressed. Finally, she got treatment, did the work and felt better. But she had no plans for how to create a different existence for herself. She refused to work at finding purpose or things to do that she could enjoy. Her last years were primarily a sad time. She spent most of her time completely isolated from others. What Does Work None of us have a guarantee of never being left alone in life. Many single people of all ages work things out, but a lot changes as we age. The risks of aging solo increase over the years. In fact, among people 85 and older, nearly half of women live alone. Planning around this possibility can make things considerably easier. And it takes effort to see the options and create a way to be successful. Here is what we see at as high quality planning for one's future, being as realistic as possible. 1. Create or expand your connections to others. Develop and expand your friendships. Join things. Show up for events. Participate in groups, like AE, above (Rotary for example), in your community. You need a network around you if you want to age solo in a successful way. People live longer and happier with community around them. Social isolation leads to poor health outcomes. 2. Make clear future plans. If you live in a place that you could not or would not want to manage alone, consider a proactive move before it is actually needed. RT, above, gave up her house, which her husband resisted doing. But her move to a supervised environment was a life saver over time. After he passed, she had a community and support every day. 3. Attend to your mental health. This is true throughout life, of course, but your emotional well-being when you are aging alone is of critical importance. Components of mental wellness include feeling included, having a sense of purpose, (like AE, above), creating enjoyable activities (OW, above), and avoiding social isolation, among other things. This well being does not come about by drifting along, making no effort to achieve good emotional health. It can be a result of a concerted effort to remain engaged in the parts of life that bring safety and enjoyment. Conclusion Concerned adult children may understand all of this. And stubborn aging parents may simply refuse all helpful suggestions. We can't make anyone who is still mentally competent do what we want. We can encourage and that can help. On a personal note, my widowed mother-in-law, who lived to be 96, insisted on living alone for all too long. We begged her for years to move. Finally at age 93, she took our suggestion to move to a seniors' community! The takeaway: don't give up. Your urgings can eventually work.
