After years of raising children and caring for the family’s needs, your parents have finally reached a point where they need a little help themselves. While it is not an easy transition, now is the time for some tough conversations about aging.
Most families find these talks difficult but with the right approach they can be productive and spare feelings. Start by identifying current health and medical needs, and research available options to address both immediate and future issues. Talking with your parents before a medical crisis occurs allows them to communicate their desires and frees family members from having to make rushed decisions during a stressful time.
Remember to listen to your parents’ concerns and respect their wishes while working together to find satisfactory solutions.
Advanced Directives and Living Wills
Written, legal instructions outlining your parents’ desires for medical care, should they become unable to make those decisions themselves, are an important part of life planning. Explain that preparing documents such as a living will and advanced directive helps ensure their wishes are carried out if the day comes when they are unable to communicate them.
- Advance directive: This document assigns medical power of attorney to an individual who will represent the wishes of your parents if their physical or mental health renders them incapable of making such decisions. It applies only to medical matters—not financial. Usually only one person is designated, although alternates may be named if the appointed person is unable to perform his duty.
- Living will: This legal document outlines an individual’s wishes concerning end-of-life treatment choices if they are unable to communicate those wishes. It covers a variety of medical decisions including cardiopulmonary resuscitation (CPR), breathing assistance, organ donation, dialysis, medications, tube feedings and palliative or comfort care.
Wills and Estate Planning
Estate planning involves the gathering and preparation of specific documents to determine how your parents’ assets will be managed and distributed after their deaths or incapacitation. Estate planning isn’t limited to the wealthy; even those of modest means should put in place a plan outlining how their properties and wealth are to be transferred. Your parents’ estate might include houses, cars, artwork, jewelry, investments, life insurance, businesses, bank accounts, possessions and debt. Some key components of estate planning include:
- Wills. This is a legal document used to transfer the estate to named beneficiaries. It addresses the distribution of assets and outstanding debt. It also names an executor to oversee and manage the process. If your parents don’t have a will, suggest they talk to an attorney about establishing one. If they currently have a will, it is a good idea to review and update it.
- Trusts. This is a legal entity that allows another party (trustee) the right to hold title to and manage assets or property for the benefit of a third party, or beneficiary. There are many kinds of trusts, and they should be set up by a qualified attorney or trust company.
- Secure a power of attorney. Unlike a medical power of attorney which is limited to health and medical matters, a Power of Attorney (POA) gives you the power to act on your parents’ behalf in managing financial and legal matters. There are two types of POAs to consider. A General Power of Attorney ends the moment your parents become incapacitated while a Durable Power of Attorney (DPOA) allows you to continue to act on their behalf should they become incapacitated due to a serious accident, severe medical condition or mental illness.
- Healthcare directives. An advanced health directive is a legal document outlining your parents’ healthcare wishes should they become incapacitated or unable to verbalize their preferences. It covers topics such as in-home or hospital medical treatment, life-support measures, autopsy or organ donation.
- Beneficiary designations. Consider naming primary and secondary recipients for insurance, 401(k) or additional assets not covered in a will.
Conversations concerning finances and money matters are often some of the most challenging because relinquishing control of money can make seniors feel vulnerable. Still, keeping up with monthly bill paying and budgeting can be overwhelming. Elderly adults are also easy targets for scams and financial fraud. Signs you may need to step in to assist include:
- Unopened mail or bills
- Careless spending or unusual purchases
- Physical or mental changes
- Complaints of not having enough money
- Calls from creditors
Talk openly with your parents about your concerns and offer to help. They might see this as a loss of control, so be gentle in your approach. Start slowly by working together to review documents and ask about areas where they might need help. The following steps will help in understanding and managing your parents’ finances.
- Gather important documents including a list of bank accounts, pensions, 401(k) information, annuities, savings bonds, brokerage accounts, stocks, property deeds, vehicle titles and any loans or outstanding debts.
- Start small by offering support with chores such as writing checks or organizing bills.
- Streamline financial tasks. Consider using direct deposit and online bill paying. This allows adult children who don’t live close to parents to still be involved in managing finances.
- Keep your parents informed and involved along the way. Review bank statements with them and discuss any actions you take.
- Maintain separate accounts. It isn’t a good idea to combine your parents’ finances with your own.
Is It Time to Give Up the Car Keys?
When it comes to driving, it is not one size fits all. Some elderly adults are still capable behind the wheel, but if you are seeing indications driving is a safety issue, it is time to act. This might be the toughest conversation of all because giving up driving has the strongest impact on independence. Signs your parents may need to hang up the car keys include multiple traffic violations, frequent scrapes and dents, delayed response times, getting lost in familiar surroundings, repeated close calls, difficulty navigating parking and steering (hitting the curb, veering over the line) and problems with concentration.
Follow these tips for having the conversation:
- Be understanding and sympathetic. Stopping driving severely impacts lifestyle. It means a loss of freedom and can limit the time spent with others. Approach the topic respectfully and gently.
- Assess the problem. Is it necessary to give up driving completely? Maybe limiting driving to daytime hours or short distances is a good compromise. If not, calmly state the reasons for your concern and ask your parent if she has noticed changes in her own driving skills.
- Do your research. What transportation options are available? Do your parents live in an area where public transportation is easily accessible? If not, most areas have services such as Uber or Lyft. Talk with other family members and friends about helping. Could a neighbor pick up your dad for weekly grocery trips? Consider coordinating your schedules. Could you book simultaneous hair salon appointments for you and your mom? Look for senior transportation options in the community.
- Involve agencies and experts. If you feel your parent is not safe behind the wheel, yet they still resist giving up driving, consider an evaluation by an occupational therapist. Would vehicle modification such as hand pedals and safety mirrors address the problem? Ask your parents to consider a safe driving course for seniors (AAA and your local DMV may offer a class). Avoid forcing them into a decision if they are resistant. Instead, make suggestions and give them time to consider their options.
Healthcare in Your 60s and Beyond
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Normal Memory Loss or Something More Concerning?
Occasional forgetfulness is a normal part of aging, but severe memory loss is not. Understand the early signs of dementia. If your parents miss paying a bill one month, misplace their keys at times or take a little longer to recall names, you can chalk it up to normal aging. But severe memory loss is cause for concern. When memory problems interfere with daily living, it could indicate mild cognitive impairment or dementia.
Mild cognitive impairment (MCI)
Some seniors experience memory loss and thinking problems that go beyond what is considered normal for their age. MCI may be a sign of early dementia, but not all individuals who suffer from mild cognitive impairment go on to develop dementia. Signs of MCI include frequently forgetting names, events or appointments. Those with MCI may lose things, have difficulty focusing, struggle to complete routine tasks or find it hard to come up with the right words during conversation. Most people with MCI can function independently but may benefit from a set daily routine, memory tools and to-do lists. If you suspect your parent has MCI, it is important to have annual (or more frequent) medical checks to track changes in memory and mental function.
There are many kinds of dementia, but Alzheimer’s is the most common. If your parent is showing signs of dementia, schedule an appointment with their doctor. Early diagnosis allows you and your parents time to make future plans and address issues that may arise. The Alzheimer’s Association lists 10 early signs of Alzheimer’s including:
- Memory loss that interferes with daily life
- Difficulty planning or solving problems
- Challenges in completing familiar tasks
- Confusion about time or place
- Vision problems or difficulty with spatial relationships
- Developing problems in speaking or writing
- Misplacing items and not being able to retrace actions or recall
- Poor judgement and issues with decision-making
- Withdrawing socially and losing interest in hobbies and activities
- Mood and personality changes
Discussing Living Arrangements
One of the biggest decisions elderly adults face is whether to age in place or relocate to a senior living community. While aging in place is an appealing option, there are many factors to consider. An open honest conversation considering your parents’ needs and desires is the best way to approach the situation.
- Social opportunities. Staying in the home means your parents are surrounded by the familiar and likely keeps them close to family and friends. Moving to an assisted living facility or retirement community may require your parents to relocate further away from their circle of family and friends. On the other hand, living alone might mean fewer opportunities to socialize with others. Many retirement and assisted living communities offer activities and provide transportation to local businesses and events, keeping seniors active and engaged.
- Access to medical care. Many retirement communities offer a variety of living options. Seniors can live independently in a house, condo or apartment with the option of transitioning to a place where more care is provided should it become needed. Couples may also remain together even when one spouse requires a higher level of care. Staying in the home might eventually require in-home care and present transportation challenges.
- Safety. Home security systems and medical alert systems are good options for those who choose to remain in their homes, but if safety is a concern, a retirement community can offer more peace of mind. Many have gated security, personnel who perform frequent wellness checks and other provisions to keep your parents safe.
- Financial considerations: The advantage of community living is that it frees residents of the burden of home maintenance and provides onsite care. However, the cost of an assisted living facility rises with the level of care required. If your parents need only minimal assistance, remaining in the home may be a more cost-effective option. But if around-the-clock care is needed, the price of in-home care may be more than that of an assisted living facility. Before buying into a retirement community, do your homework. Some facilities require a substantial entrance fee. It is also important to note whether the facility is a for-profit or non-profit community. Both have their own financial risks, and it is vital that you read the fine print and understand the contract.
- Review the rules: Retirement communities and assisted living facilities offer less freedom than living at home. If your parent balks at following rules, the transition may be difficult. Are overnight guests allowed? What are the parking restrictions? Be sure to carefully review all requirements and restrictions before signing on the dotted line.
Help with Medication Management
According to the Centers for Disease Control and Prevention (CDC), 42 percent of adults aged 65 and older take five or more prescription drugs, and the Lown Institute reports nearly 20 percent of older adults take 10 or more medications. Managing multiple medications is a daunting task for elderly adults. It is understandable that your parents may need help keeping track of prescription and over-the-counter medications. Ways to help with medication management include:
- Review all medications with your parents, including which medicines they take and why, noting any specific instructions (take with food, take as needed, etc.).
- Make a list of medications and drug allergies and encourage your parents to carry the list in their wallet or handbag.
- Develop a system for taking medications. Purchase separate pill boxes for morning and evening meds and prefill them weekly.
- Encourage your parents to set an alarm to remind them when a medication is due, incorporate medications into a routine (take morning pills after brushing teeth, evening pills after dinner), or arrange for a family member to call with a reminder.
- Invest in a digital medication dispenser. Some come with a compatible phone app that sends a reminder to your parent or loved one if a medication is missed.
- Provide a notebook where “as needed” medications can be recorded so they can remember the time of their last dose.
- Stick with a single pharmacy so all medications can be easily tracked. This also allows the pharmacist to watch for medication interactions and other concerns.