Dealing with the Financial Stress of Caring for Aging Parents

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Sandra Tsing Loh is one of my favorite writers, even though the only work of hers that I’ve read are her book reviews in the Atlantic. Every month when a new issue of the Atlantic arrives, I hurry to check and see if Sandra Tsing Loh has an article in this month’s issue, and if she doesn’t, I’m actively disappointed. Sandra writes about marriage, careers, parenting, education, the relationships between women and men, the assumptions and compromises we all make about what makes a “good” prosperous middle-class life, and whether it’s all worth it in the end.

Her latest article, in the March issue of the Atlantic, is called “Daddy Issues.” It’s a sobering and yet sometimes very funny story about her difficult relationship with her 91-year-old father and how, due to his various health problems and the associated stress and expense they are inflicting on her family, she sometimes finds herself wishing that he would die.

This article is essential reading for anyone who has aging parents, or whose parents will someday become aged, or for anyone who hopes to one day grow old themselves. It highlights some of the impossible, expensive choices that families face when a loved one starts to get old.

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Sandra Tsing Loh’s father is wheelchair-bound and suffers from advanced Parkinson’s disease, but he still wants to live in his own home and lead an active life. His much younger wife (72 years old), Sandra’s stepmother, is suffering from early onset dementia, which means she can’t take care of her husband. This means that Sandra and her siblings have had to hire a full-time $65,000 a year live-in male nurse to take care of her father, because her father is not the easiest person to live with (to say the least) and all of the other nurses resigned after only a few days with him.

Even though Sandra’s father receives Social Security and Medicare benefits, there are many aspects of long-term care that are not covered by any federal programs.

For example, nursing home care and certain types of assisted living are not covered by Medicare. Seniors can pay for nursing home care with Medicaid benefits (the federal-and-state funded program of health care for the poor) but they have to spend all of their money to become “poor enough” to qualify for Medicaid.

This puts families in a delicate situation of trying to do “Medicaid planning” to decide how/whether/when to “spend down” their mom or dad’s money, or transfer assets to family members, in order to keep some money in the family rather than spending it all on nursing home care. (Nursing homes can cost $75,000 a year or more. Many seniors spend their last dollar on nursing home care during the last years or months of life.)

Every family’s situation is different and there are almost never any “good choices” when it comes to dealing with a family member whose health is failing. Often the aging parent doesn’t fully want to admit to the extent of the problem – elderly people might want to stay in their own homes longer than is safe or advisable.

Sometimes the children have to initiate tough, painful conversations about how to help manage the daily affairs of their parents. The emotions involved in caring for an aging parent can be especially difficult to navigate. Unpleasant family dynamics and old resentments might come roaring back as siblings disagree or second-guess or undermine the decisions about how to care for their parents (and who should pay for the care).

None of this is easy or pleasant or fun to think about, but it’s a reality for millions of families. Here are a few resources that you should read if your family is wondering about how to handle the financial pressures of long-term care for an aging loved one:

The New Old Age blog (New York Times): This blog has a wealth of information on how to navigate the complexities of the process of being a caregiver for an aging parent, grandparent or spouse. The information is especially relevant to Baby Boomers who are helping care for their aging parents. This blog will teach you how to be a good advocate for your loved one, negotiate the best possible care, and understand the options at each step of the way.

National Association of Area Agencies on Aging: Wherever you live in the U.S., there is a local Area Agency on Aging dedicated to connecting the elderly with the services and benefits available to them. This is a good starting point if you want information on anything from meals-on-wheels to home health aides to transportation assistance. Your loved one might qualify for special benefits or subsidies to reduce the cost of medication or help pay for Medicare premiums, for example.

Kiplinger’s article on Medicaid Planning: Medicaid planning is a complex subject that you should probably discuss with an attorney who specializes in estate planning. This article has some good information on how new Medicaid rules might make it harder for some families to preserve their older loved ones’ wealth.

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Despite the financial challenges of getting older, the good news is that more help is available than ever before. There are more options to help aging adults live independently in their own homes for as long as possible. There is assistance and information available, starting online, to help caregivers make the best of the situation. You are not alone.
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