My years of education and experience as a Certified Elder Law Attorney (CELA) prepared me well for the day when my father began experiencing lapses in memory. I knew what documents to prepare, what information to have on hand, and how to organize all these things so that they were easily accessible.
I wish to share my strategies for navigating the legal, financial and medical issues that arise when a senior develops dementia or experiences another health setback that necessitates a family member’s assistance.
Essential Legal Documents for Seniors and Their Caregivers
Family members must often make decisions on an aging loved one’s behalf while they are recuperating temporarily or on a permanent basis if they are incapacitated due to a condition like dementia or a severe stroke. In order to seamlessly participate in decisions and handle routine affairs, power of attorney (POA) documents are crucial. Having both medical and financial POA documents in place before anything goes awry with a loved one’s health will make your job as a caregiver much easier.
Third parties like banks, insurance companies and health care providers all require proof of a valid POA document that contains specific language before they will discuss a senior’s medical care or financial information with someone other than the patient or the account holder. In cases where a loved one is beginning to experience cognitive decline, it is important to draw up these documents before they become too incapacitated to do so.
As soon as I began noticing my father’s memory issues, I made an appointment for both of us to meet with his attorney to put the proper legal documents in place so we were prepared for what was to come. Dad’s attorney drafted and notarized the financial POA papers that allowed me to make deposits into my father’s accounts, pay his bills and cancel his credit cards. My sister was designated as the alternate agent, in case anything happened to me.
The attorney also prepared a health care proxy document (also known as a durable power of attorney for health care). This granted my sister legal access to Dad’s medical information and the ability to participate in decisions regarding his care at the local hospital, the VA healthcare clinic and any other medical providers.
Making Long-Term Care Decisions for a Senior
Years of working with seniors and their families also helped me become familiar with the various levels of community-based and residential care available to elders. Understanding the differences between independent living, assisted living, memory care and nursing homes can be difficult.
To help my family understand the choices that were available to my father at that point in time and as his dementia progressed, I made a chart that listed senior living facilities and elder care resources in his hometown along with their costs and the services each provided. When he declined further and began noticeably struggling to maintain his daily routines, it became evident that it was time for him to move out of his apartment. We compared his increasing needs for assistance to the information on this chart and concluded that an assisted living facility nearby was the best fit for him.
Because my father was chronically ill, some of his assisted living costs could be considered a tax-deductible medical expense. So, I obtained a statement from the nurse practitioner at Dad’s VA clinic, who is considered a licensed health care practitioner under the federal tax laws, IRC Sec 7702B(c)(4). The statement she gave me certified that my father needed the services provided by the assisted living staff to manage his activities of daily living.
My father’s accountant then used the nurse practitioner’s statement to deduct the assisted living expenses from my father’s income. It turned out that he did not have to pay income taxes during the years he was in assisted living.
Strategies for Managing a Senior’s Finances
My father had several longstanding bank and investment accounts. Many of the banks had merged and changed their names over the years, so it took lots of organizing and detective work to match old account statements and files with the financial institutions’ current names. I know that many caregivers struggle with tasks like these when they first appear on the scene and try to make sense of an aging parent’s finances.
The first step I took was to make a list of all the accounts I could find evidence of. This included the old former names of financial institutions and information pertaining to Dad’s social security retirement benefits and required minimum distributions from his IRA. I updated them as best I could and then got to organizing this information so I could make a budget.
In a simple, three-column chart, I listed the name of each account, the principal balance in each account and the monthly income it produced. I called this chart “Schedule A.” Looking at Schedule A, I knew how much income my father would have each month.
I made another chart showing his expenses. This two-column chart, which I called “Schedule B,” listed the name of each expense and the monthly amount.
I updated Schedule A and Schedule B every month and sent copies to my brothers and sister, so they could see how my father’s needs were being met. I subtracted the expenses paid in Schedule B from the principal balance of Schedule A and listed the result as Schedule C. That way, everyone could always see the financial resources that remained available for our father’s care.
I used this simple monthly accounting method to keep track of income and dividends that came in and the costs of care that went out. In the end, everyone in the family was able to see exactly how his money had been used. This straightforward, transparent budgeting method helped avoid disagreements among my siblings because there was no misunderstanding Dad’s financial situation.
The probate courts in the state where I live (Massachusetts) use a similar format to account for funds of people who cannot manage their own money. Ideally, your family won’t be required to account for your loved one’s expenses and income in court, but these probate account forms provide an example of my format to help you privately organize a loved one’s financial information.
Organizing a Senior’s Medications
The other organizational tool I used was for medications. My father was taking 15 different medications and supplements when he moved into his assisted living apartment. Not only did the facility want a careful account of everything he was taking when he moved in, but my family and I also wanted a way of tracking what all he was taking and why. So, I devised a medication management checklist to help my sister sort out Dad’s medication regimen (remember, she was named as his health care proxy).
The purpose of this checklist is to help prevent polypharmacy, which can occur when different doctors and specialists prescribe a variety of medications, resulting in duplicates or even drugs that conflict with each other. The completed chart also helped us find the right Medicare Part D Plan for Dad and maximize his benefits. We even found that the VA offered a cheaper alternative source for one of his medications.
The chart I created lists the name of each medication, the dosage/frequency, the reason for the medication and the physician who prescribed it, along with the source of payment and the date it was begun and/or discontinued. Once you see all this information together on the same sheet of paper, you can ask better questions when you take your loved one to doctor’s appointments, get better advice when you fill prescriptions and make more informed decisions about health insurance coverage.
In my father’s case, the information on this chart changed monthly. We would not have been able to keep track of all the constant medication changes without using this written tool. For example, when my father began falling frequently in assisted living, this checklist helped us troubleshoot with his physicians. The first thing doctors usually check when a senior starts experiencing regular falls is their medication regimen, but we quickly figured out that his prescription drugs weren’t the culprit. In fact, Dad had an irregular heartbeat that was causing sudden drops in blood pressure and fainting spells. After they implanted a pacemaker, the mystery was solved.
Getting Organized As a Caregiver
Whether you’re just starting to get involved in an aging loved one’s health care and finances or you’ve been caregiving for years, the truth is that it’s never easy to manage important information and decisions for another person. Keep in mind that memory loss and dementia are symptoms of a mental condition, so things are likely going to be in disarray when you first get involved. It’s a tough job, but taking the steps necessary to organize a loved one’s financial information and medical records can help make things much easier for you in the long run. It took many months for me to put these charts and accounts together for my father’s care, but we could not have provided him with the type of support we did without them.