1. WHERE? Should an individual who needs care stay at home, or go somewhere else?
3. HOW MUCH ENERGY? How much time and other non-cash support can an individual's relatives, friends and neighbors provide?
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Financial advisors wear many hats when providing their clients with guidance about their futures, and fielding questions about care for aging parents often comes with the territory. Choosing the right care for an aging parent is a challenge many people will face and there are so many options that it can be difficult to know where to begin.
Clients may call on you for advice on a variety of questions relating to their aging parents, from how to select the right type of care to how to pay for that care. The better you understand the elder care landscape, the better prepared you will be to provide the informed guidance your clients hope to receive.
The first step that clients should take when considering elder care is to assess the level of care needed. Doing so involves evaluating of a number of considerations concerning the abilities and resources of the care recipient, such as:
- Can they groom themselves and maintain overall hygiene?
- Can they walk from the bedroom to the bathroom or kitchen without a risk of falling?
- If the phone rings, can they hear it and answer it in a safe and timely manner?
- Can they clean the interior of their home?
- Do they exhibit confusion and, if so, is it mild, moderate or high?
- Do they require assistance with medications?
- What type of community and family support is readily available?
Answering questions like these on the adequacy of parent safety, health and self-care, as well as resources at their disposal will help in determining the level of care assistance needed. Getting advice from physicians or other healthcare professionals familiar with the parent’s medical condition and obtaining an assessment from a qualified in-home care professional are additional steps to recommend that can give a full picture of the amount of care required.
Of course, the level of care needed can vary widely, from in-home companion or personal care visits to skilled care at home or in a nursing facility. Along with financial resources available, the level of care needed will be the primary determinant of the financial implications of care.
Developing a detailed financial plan for care will require evaluation of several important considerations. The following are among them.
- Is in-home care or care in a retirement/nursing home facility more appropriate?
On average, in-home care ranges from a minimum of 3 days a week for 4 hours each up to 24/7 round the clock care. Costs will vary depending on whether the care is provided by a caregiver or a nurse.
If in-home care is being considered, advisors should make sure their clients are comparing the qualifications of home care agencies to identify the best quality of care. From a financial perspective, an agency that has their own liability insurance for accidents that occur while they care for the individual in the home can help avoid unexpected and costly liability issues for the care recipient. It’s best to seek out an agency with caregivers specifically trained to handle a senior’s unique needs, especially in cases involving Alzheimer’s or other forms of dementia. The best agencies also have a staff of equally trained and qualified caregivers that can act as a backup option if the primary caregiver has an emergency. For cases that may evolve in something more than non-medical care, it is important to find an agency that does have registered nurses available when needed. Some agencies also offer registered nurse oversight on every case to serve as a liaison between caregiver and client in developing a medically sound and truly personal plan of care. This would be especially important for clients with complex care needs like those with diabetes, heart failure, stroke and other neurological disorders, and dementia
If in-home care is not advisable for reasons such as excessive cost or client safety, care in a facility may be the best choice. Costs for facility care will vary depending on whether an assisted living environment is appropriate or skilled care is needed. Many continuing care retirement facilities also require a significant buy-in payment.
- What financial resources are available for the care needed?
As a financial advisor, clients will look to you to help them evaluate the amount of personal assets available for care and to develop a financial plan. However, consideration should also be given to additional resources that may be available. For example if the aging parent has few or no assets, they may be Medicaid eligible, which may cover certain personal care needs at home. However, in planning it is important to be aware of the fact that Medicaid benefits vary by state. Moreover, assisted living facilities in many states won’t accept Medicaid and in states where they do, there is often a waiting list for coverage.
Medicare may be another source of financial assistance. However, Medicare has very defined limitations on what it covers, which for in-home care tend to be short-term needs. Medicare advantage programs offer additional coverage.
It will also be important to determine whether long-term care insurance (LTCI) has been purchased and is available. It is a common misconception that LTCI only covers nursing home care, but most programs will cover in-home care as well. In addition to private LTCI plans, veterans may qualify for LTCI benefits through the government.
If the aging parents needing in-home care own a home, it may be appropriate to consider whether care should be funded through a reverse mortgage. As a financial advisor, you will want to make sure that both your client and the care recipient homeowner understand the implications of the reverse mortgage and that the terms make sense in light of their total financial and health picture.
- What non-financial resources are available?
As discussed, getting advice from physicians or other healthcare professionals familiar with the senior parent’s medical condition and obtaining an assessment from a qualified in-home care professional are additional steps to recommend to your clients as they evaluate care options. Similarly, in some situations, including those where clients want to navigate receiving government assistance, it may be advisable to recommend that they seek the advice of an attorney specializing in elder law and contact their local county offices Area Agency on Aging or the Aging and Disability Resource Center. Moreover, organizations such as AARP and our BrightStar Care resource page offer additional valuable educational information that can help your clients understand their options.
As a trusted financial advisor, it is very likely that you will be asked to help evaluate the financial implications of care options for a client’s aging parent or parents. Being prepared to give them the informed guidance they are looking for is certain to be appreciated by them and great for the advisor-client relationship.
Sharon Roth Maguire, MS, RN, GNP-BC, oversees the clinical-quality platforms for BrightStar Care and BrightStar Senior Living.