A successful conversation depends to an extent upon the relationship we have with the parent, as well as on the parent's mental, emotional, and physical condition. While many people put off serious conversations to avoid conflict or awkwardness, both parent and adult child may lose an opportunity for closeness, understanding, access to information that may affect the decision, and optimum peace of mind. To the extent possible, talk with your elderly parents gently and honestly about their wishes, their abilities and their options. Far more often than not, these conversations are helpful and put the adult child in a better position to make decisions later when the parent may not be able to do so.
The following are suggestions for conversations with your elderly parent:. If this kind of conversation seems impossible or the situation and relationship with the elderly parent become overwhelming, professional counseling may be very helpful. You may also consider using the Department of State's resources to approach this delicate issue somewhat indirectly.
You may also wish to raise the subject of long-term care insurance. Physicians and geriatric social workers warn that there are a number of danger signs that indicate an elderly person needs extra help or a change in living arrangement. Any marked change should be noted; however, no change in lifestyle should be made without discussions with the elderly person, other family members, and doctors or other health professionals.
Eldercare Housing Options return to top. There are many housing options available to the elderly. Choosing the best one will depend on the elderly person's preference, age, health, and financial condition.
How to Advocate for a Loved One In Long-Term Care
Begin with Resources for Finding Help with Eldercare which can assist you when considering the options. There are several types of retirement communities that provide living arrangements and services to meet the needs of both independent seniors and those who need assistance. It is important when investigating these housing options to understand completely the services provided and the cost. If the elderly person is not capable of independent living, a nursing home may be the appropriate option.
Nursing homes offer two levels of care - skilled nursing and intermediate care — depending on the patient's needs. Most nursing homes offer both levels of care on a single site.
U.S. Department of State
Paying for Long-Term Care return to top. It is important to understand the different types of insurance that are available to older people. Many people believe that Medicare will cover long-term care needs. Medicare is a Federal health insurance program, which helps defray many of the medical expenses of most Americans over the age of Medicare has two parts:.
Part A Hospital Insurance helps pay the cost of inpatient hospital care.
Diplomacy in Action
The number of days in the hospital paid for by Medicare is governed by a system based upon patient diagnosis and medical necessity for hospital care. Once it is no longer medically necessary for the person to remain in the hospital, the physician will begin the discharge process. If the person or the family disagrees with this decision, they may appeal to the state's Peer Review Organization. Medicare does not pay for custodial care or nursing home care. It will, however, cover up to 60 days in a nursing home as part of convalescence after hospitalization.
Part B Medical Insurance pays for many medically necessary doctors' services, outpatient services, and some other medical services. Enrollees pay a monthly premium. Medicaid is a joint federal-state health care program for people with a low income. The program is administered by each state and the type of services covered differs. There are strict income requirements so it is necessary for the person to "spend down" all income and assets to poverty levels before becoming eligible. Medicaid is the major payer of nursing home care. The Medicaid requirement to "spend down" all income and assets created a great hardship for the spouse of a person needing nursing home care.
Changes in the Medicaid rules now allow the spouse to keep a monthly income and some assets, including the primary residence. The amounts allowed change, so you must check for current levels. Why buy other insurance? The purchase of additional insurance gives the policy holder access to a greater choice of facilities without dipping into additional financial resources. Medigap is privately-purchased supplemental health insurance designed to help cover some of the gaps in Medicare coverage but does not cover long-term care.
Study Medigap policies carefully to be sure they provide the protection needed and do not duplicate other health insurance. Long-Term Care Insurance is a private insurance that is usually either an indemnity policy or part of an individual life insurance policy. An indemnity policy pays a set amount per day for nursing home or home health care.
Senior Advocates | How to Advocate for Loved Ones In Long-Term Care
Under the life insurance policy, a certain percentage of the death benefit is paid for each month the policyholder requires long-term care. Policies are priced differently depending on the age of the policyholder, the deductible periods chosen, and indemnity value or duration of benefits. Information about other long-term insurance is available from: Postal Service employees and annuitants, active and retired members of the uniformed services, and their qualified relatives.
Resources for Finding Help with Eldercare return to top. Each program has unique services for that agency. Please see below and visit the respective websites for more information. Department of State WorkLife4You. Counselors will help determine what services are needed and available, including adult care, in any U. Their website features information on caring for an aging loved one, discussing caregiving options with your loved one, adult care information worksheet, caregivers of older adults, managing work while caring for your loved one, and geriatric care management services.
Contact them to request an Eldercare Kit that features caregiving guidance, checklists, and resources information, as well as a few useful practical items such as a pill sorter, night light, and jar opener. Staff Care for You. Among other services offered is expert guidance and personalized referrals. Specialists will save you time by helping you find anything you need, to include: They can also provide Be Well Kits full of helpful info and products.
Contact Information toll free: Clinical social workers offer brief counseling and help in coordinating an evaluation and assessment anywhere in the United States. ECS social workers act as a liaison in providing appropriate and necessary services for the elderly. All services are free and confidential. In Washington, make an appointment for a personal consultation; from overseas write or cable for advice.
ECS also conducts eldercare support groups for employees and their families who are responsible for an aging relative. The groups meet at the State Department to share issues, resources, and approaches to the problems that arise as an elderly person declines, including the issue of emotional stress that occurs for family members watching such decline. Department of Health and Human Services. It was set up to "remove barriers to the economic and personal independence of older persons and to assure the availability of a range of appropriate community and family based services for older persons in social or economic need.
For information on eldercare services in a particular community, contact the Area Agency on Aging. Locate a specific state agency on aging through the Eldercare Locator Service or telephone Private geriatric care managers are professional social workers and nurses who assist the elderly and their families by assessing needs, coordinating services, and monitoring care, for a fee.
They are particularly helpful when long-distance care giving is necessary. Fees vary and are sometimes covered by Medicare or private insurance. Any of the referral resources mentioned as well as community agencies can provide referrals nationwide. If the older person has been hospitalized, hospital discharge planners can also provide information and referrals for after-care.
Some private companies have set up programs to help their employees with eldercare. Foreign Service spouses who work in the private sector should investigate any eldercare options offered by their employers. These programs can include seed money for eldercare services, flexible work schedules for caregivers, subsidies for eldercare expenses, unpaid leave for up to a year, referral services, inter-generational day care centers for both the elderly and children , geriatric assessment and case management, and group rates for long-term care insurance. Unfortunately, many of the services provided by companies require that the elderly person meet the tax law definition of a dependent.
This increases the burden for families whose elderly relatives are not financially dependent or who are not living with the employee. Eldercare in the Foreign Service return to top. Foreign Service employees may request that their elderly relative s including step parents and legally adopted parents be approved as an eligible family member and added to their Post Assignment Travel Orders for an overseas assignment.
Travel orders cannot be authorized for newly-acquired eligible family members until the HR Technician receives the OF form. Along with a completed OF form, the officer must prove that the relative has resided with the employee for at least 6 of the last 12 months, with some exceptions noted in 14 FAM , is at least 51 percent dependent for support subject to review and approval per 14 FAM ; USAID employees should also see Supplement 1B to HB 32, Chapter 1. This is termed passing the "financial support test.
Other documentary evidence may be required by the employee's agency. These documents are attached to the completed OF form and sent to the officer's agency as specified on the forms.
Requests are reviewed for approval by a Personnel OF Committee. Note that the parent may only be on orders as an EFM for one tour. The employee must reapply for another overseas posting. Employees of other agencies should contact their HR representative. For more information download Adding Parents to Your Orders. For details regarding official government support, see Taking an Elderly Relative to Post. MOH parents are responsible for acquiring their own visa for entry and residence in the host country.
Upon request, the Human Resources Office at post may assist in the process in accordance with local laws. Some countries require additional documentation by the accredited employee and all countries hold the authority to approve or deny any visa. Furthermore, they do not have diplomatic status with the host country and are not entitled to access the U.
However, the Health Unit may provide them with a list of referrals for local medical professionals. Finally, MOH parents are not eligible to receive airfare or allowance payments in the case of evacuation from post. If you think you may need to care for an elderly relative, be sure to check the provisions of the Family Leave Act on taking leave for this purpose and contact the a leave specialist in your agency.
In January , the Eldercare Emergency Visitation Travel Eldercare EVT - 3 FAM provision was implemented, permitting travel at government expense for employees and eligible spouses serving at an overseas post who need to assist parents in declining health. Eldercare EVT allows the employee two trips over a career to visit his or her parents. Every spare moment was taken up looking after one or the other.
Dementia is a scourge, a thief that steals memory, the ability to process thoughts and to live independently. Residential care homes for the elderly are not a new phenomenon — they have been around at least since the s. Demand has soared, though, as changing lifestyles reduce the care available within the family.
The latest figures from care consultancy LaingBuisson show that around , people aged over 65 live in a care home. Quite apart from the emotional aspects of putting someone you love in a care home, the financial burden is horrendous. The solution in the end was a care home. But in solving one problem, we created a new one — how to find the money to pay for it. With 44 per cent of people in care homes paying their own fees, many others will find themselves in the same boat.
So, for anyone considering permanent residential care for an elderly parent, here are my 10 tips for reducing or removing the burden. So get a sturdy file and start gathering info. Because if you later seek a quote for an immediate needs annuity, or claim a care-related benefit see tips 7 and 8 , you will be asked endless questions about accidents, illnesses, hospital referrals and prescriptions.
The more information you have, the better your chances of securing the highest possible payouts. You also need to know just as much about their savings, income and investments. This will help you to see what funds are available, if state aid can be applied for, or how you might plug a shortfall. Get sale and rental values for any property owned by your parent. If the next step is clearly residential care, should you go for the most expensive and risk running out of funds? This is a major fear for many families, but in many cases a sale can be avoided.
There may be sufficient savings, investments and income to cover the fees without resorting to a house sale. Depending on where the house is located, it may also be possible to generate a healthy stream of rental income which, combined with pension income, is enough to cover the fees. If one parent continues to live in the house, your local council cannot suggest that it is sold or used to repay fees funded by them, even if it is the only asset to speak of. It has to be disregarded. If your parent loses mental capacity before the power of attorney is created, you will need to apply to the Court of Protection to be appointed as a deputy for your parent.
Details can be found at the website of the Office of the Public Guardian. First, fees will be paid or partly paid by the local authority where savings fall below a certain threshold see box below. But only assets and income owned by the person can be counted: If your parents have a joint savings account, only half of the money can be taken into account by the local authority, and if they receive a pension, only half needs to be counted. Third, the first 12 weeks of care for anyone selling their home who would otherwise qualify for help will be funded for free by the local authority.
Finally, people who need residential care purely for medical reasons, for example because they have had a stroke, will not have to pay fees regardless of their savings and income. Note that where assets have been deliberately given away to avoid fees, your parent will be assessed as if they still had the assets regardless of whether they can get them back or not.
Your parent may then need to move to a cheaper home or you may need to make third-party top ups. Alternatively an arrangement called a deferred payment agreement DPA can be set up with the local authority so the property does not have to be sold straightaway. The council will pay the care home fees for as long as needed and place a charge on the property. When it is finally sold, the debt built up will be repaid along with interest, at a rate set by the government and currently about 2 per cent.
Whether sold or secured, the first 12 weeks of care will be funded by the local authority and this money does not need to be paid back. The advantages of the DPA are that you could benefit from house price gains, and in the meantime you can let the property and use this stream of income to reduce the final debt. You must of course keep the home insured — not only will it be easier to get insurance if you let it but the rental income can pay for the policy and other upkeep costs.
There are two main benefits three in Scotland worth thousands of pounds a year available to people aged 65 or over, who are assessed as needing either personal care or nursing care or both. They are not means-tested or taxed, so for anyone funding their own care they are a big help. Note that dementia sufferers typically only need personal care. You can receive both at the same time but only if you have been assessed as needing both types of care. In Scotland, a third benefit is available: Wherever you live in the UK, if your care home fees are paid, any of the above benefits received will be clawed back by the local authority.
In exchange for a lump sum, an immediate needs annuity will pay out a fixed or rising sum every month until the death of the annuitant. If the annuity is paid direct to the care home, no tax is due on the payments. The downside is that if death occurs early on, the capital handed over is lost forever. You can secure even higher payouts by deferring them for a couple of years.