How do you take care of your parents when they’re no longer able to take care of themselves? It’s one of those uncomfortable medical question that many prefer avoiding altogether. But with all things, the sooner you plan and the sooner you come to terms with the fact that your parents will need an end-of-life strategy, the less stressful the process will be. “Start the dialogue with your parents early enough so that they can make their wishes known,” says Robin Cohen, an Upper East Side legal recruiter who made medical decisions for both of her parents. “Everyone should discuss these things way in advance, even though it may not be a pleasant topic.” Below, a few tips to get you started.
Include your lawyer—and your accountant—in these early discussions.
As Cohen puts it: “If you’re wealthy, you can afford to pay privately. If you’re poor, it seems like everything can eventually be covered by Medicaid. And if you’re middle class, you pay out of pocket until you’re poor enough to qualify for Medicaid.” But there are plenty of ways to lessen the financial burden, including loans and elder-law attorneys who can make sure that all your documents and finances are in order.
Take advantage of social workers.
Did you know that whenever an senior citizen is hospitalized for any reason in New York State, a social worker will meet with the patient before sending them home? Seize this opportunity to ask questions. You can also hire a geriatric social worker to manage your needs like a college counselor. They can help families find resources, arrange benefits, and ease the transition from hospital to home or nursing home.
When shopping for facilities, think long-term.
A few thousand dollars per month in fees for constant care may seem feasible in the short term, but your parents may require a facility for years. It’s always a good idea to find out in advance whether a facility will let you switch to Medicaid in the future. Geriatric social worker Susan Birenbaum suggests checking medicare.gov for nursing-home rankings, as well as the National Long-Term Care Ombudsman Resource Center. “Visit, if possible, more than one time” before committing to a facility, Birenbaum says. “The most modern and beautiful facility does not necessarily mean it provides the best care.” She advises asking about staff turnover, “person-centered care” (which means that patients have the freedom to set their own schedule), and “consistent assignment” (which means that the same group of staff members take care of the patients). And, of course, you should always trust your own instincts.
A home aide should be your partner, not just your employee.
Birenbaum urges everyone to use licensed home-care agencies, where “the home health-care aides are trained, supervised, and backed by an organization.” You can find them through your physician, hospital, social worker, or the New York State Department of Health (nyhealth.gov). But if there’s one thing Cohen wishes she’d known beforehand, it’s the importance of finding the right individual home aide. “There is no good or best or go-to agency,” she says, “only good, caring people—and they can be found in any agency.” An ideal aide should check in with you at the beginning and the end of each day; if you drop in for a surprise visit, you should see dirty laundry in the hamper (indicating that clothes have been changed) and a well-stocked refrigerator. And remember: If you have any doubts about your aide, you can always ask for another.