What do boomers who are part of the sandwich generation do when the senior-most layer starts to separate from the family structure?

Financial advisors offered suggestions about how boomers should help transition an elder to the next step of care, whether it is a nursing home or assisted living facility, following an event that makes it clear a new approach is needed.

Karen Eddy, a certified financial planner with Eddy Financial Planning, San Diego, starts at a simple place. “Flesh out the problem. Is the parent competent? If so, the parent decides.”

If the answer is not clear, then Eddy suggests that the parent’s primary doctor conduct an exam of mental status and neurological acumen. Eddy draws on 30 years’ experience as a licensed social worker with the last 10 specializing in seniors before she became a financial planner.

What are the red flags? “Leaving burners on the stove carries more weight than if the house is messy,” she explains.

Eddy says there are a number of ways to seek help in determining the next step for a parent. If the parent is in the hospital or receiving home health services, then social workers can help children with placement decisions.

Geriatric care managers are also options for boomers who need professional advice on the futures of their loved ones.

Financial planners can ease the transition by reviewing their clients’ durable power of attorney for health care directives to determine who has this power and what it allows a person to do, Eddy explains.

As a boomer, Eddy has gone through the experience of having to assess whether her father needed more care. Reports from neighbors, relatives and friends that her 88-year-old father was becoming forgetful, as evidenced by missed appointments and forgetting to make an estimated IRS tax payment, prompted Eddy to contact her father’s physician, who performed some neurological tests and a mental status exam.

While Eddy’s father was able to remain at home, Eddy did pay for a cleaning person to come in twice a week. She says that as with her father, seniors sometimes object to such assistance.

For those who are recovering in a nursing home after a hospital stay of three consecutive days or more and are receiving Medicare benefits, the first thing to understand is how Medicare works, says Sharon Luker, a certified financial planner and holder of C-LTC and certified senior advisor designations. Luker, owner of LTC Planning Consultants, Plano, Texas, works with many financial advisors who have clients considering the next step for parents.

If Medicare requirements are met, the first 20 days for a temporary nursing home stay will be paid for by the program, she explains, but it is important that the patient is showing signs of getting better.

At the appropriate point, the family needs to ask doctors and the facility staff, “Do you think my loved one is able to come home, or should we plan on her remaining in the facility?”

If you want to eventually put someone on Medicaid, then you have to make sure that there will be Medicaid beds, Luker says. Some facilities require up to 6 months payment in the bank so that they will have expenses covered if a Medicaid bed is not immediately available, she adds.

Medicaid planning can take months and should involve a consultation with a Medicaid attorney since the laws have become much more stringent, Luker says. “You can stumble very easily.”

Planning should also include checking out facilities, she says. So, for example, when a relative was getting ready to be placed in a facility, Luker actually arranged to stay several days and assess how it was operated. If this is not possible, Luker recommends ‘drop-by’ visits to get a sense of the type of food that is served and the recreation facilities offered.

When the time comes, she says, try to move the family member just once. “The elderly hate change. Changing rooms can be like moving cross country.”

If you want the person to stay, according to Luker, then you need to go to the administrator of the facility and find out about the next step–moving them into a regular room. And, if the family decides to bring the person home, then part-time and possibly full-time care needs to be arranged.

Boomers, says Luker, need to honestly ask themselves, “Can [their parents] really be there by themselves? How bad is it?”

Once that question is answered, they need to calculate how much it will cost and where the money will come from, she adds.

Kevin Gahagan, a certified financial planner with Mosaic Financial Partners Inc., San Francisco, offers some points that a planner should go over with boomer clients (see chart).

The discussion about parents takes place as part of the general financial planning process, Gahagan says.

Diane Pearson, a wealth manager with Legend Financial Advisors, Pittsburgh, says she first determines what the client’s goal is. After a hospital stay, does that boomer client intend for the parent or elderly relative to recuperate during a temporary stay, or will the stay be more permanent?

If the stay is permanent, the healthy spouse may want to live in a facility where there is a campus and they can readily visit their partner, she adds.

But some boomer clients just feel that the quality of care will be better at home, says Pearson. If the boomer client opts for home care and alterations are needed on the parent’s house, then there may be tax deductions that can be taken, she says.

For those who intend to put the relative on Medicaid, it needs to be determined by an expert how much should be drawn down and how much can be retained by the debilitated person’s spouse.

Owen Hill, a certified financial planner with Tahoe Financial, Lake Tahoe, Nev., is facing the likelihood that he will become a guardian for a relative. If a person needs care and is married, the process can be simpler, he says, but if the person does not have a spouse or that spouse is incapable of making decisions, then a boomer relative may have to get guardianship over that person’s finances and health care.

He is starting to hear more about these issues from clients, he says, among which are concerns about finances. Making next-step decisions for parents or elderly relatives will become more common for boomers, according to Hill.

Kicker: When Boomers Need Help

1. Ask how their parents are doing.

2. Discuss concerns they may have about their parents’ health/cognitive skills.

3. Discuss alternatives they may be considering and our understanding of each.

4. Discuss family dynamics that may be in play and how to approach the parent.

5. Share personal and client experiences relevant to their situation.

6. Help them develop/articulate a plan for dealing with the situation.

7. Link them up with other professional resources.