Most bankruptcies are a result of catastrophic illness. This is even truer as people age. On the same vein, the number-one fear of elderly people is that they will outlive their assets, and spend their last years in a low-grade nursing home or be a burden to their family. I will briefly try to explain what the family can do to insure there are ways to access quality nursing and end-of-life care in this entry.
At LifeSpan, we are most often called when an elderly member in the family has had a major life event (i.e., a fall, hospitalization, etc.) and the assets of the family are near depleted. We are asked to do the near-impossible: find my mom an assisted living apartment or a nursing home bed, and by the way, we have no assets and we haven’t yet applied for Medicaid.
Sometimes we are able to do the near impossible, but only after doing a thorough assessment of the situation: health history, life history, assessment of the value beliefs of the family, eligibility for “entitlements” (i.e., Medicare, Medicaid, Veteran’s benefits, etc.), and the current assets (house, life insurance, pensions, etc.) that the client may have. We often work with the Estate or Elder Law attorney to parse out the value and access to sources of funds to pay for care, as there are legal ways deploy assets or to shield assets to enable the elderly and disabled to life a comfortable lifestyle in their “Golden Years”.
To avoid outliving their assets, the family needs to take the following steps to assure that the parents will have proper care at the end-of-life:
- PLAN for the future. If your parents won’t talk about it, this is a sign that you need to redouble your effort to do so, DENIAL being the first stage of death and dying.
- GET HELP. An experienced family financial planner, accountant, Estate or Elder Attorney is worth the money and can say things (that need to be said) that the sons and daughters do not feel comfortable saying. Of course, an experienced nurse care manager can spot early symptoms that will lead to functional losses and assist with practical plans that delay or mitigate functional losses.
- Take into account the level of current function of the parents, and the natural course of chronic illness. Plan out for five years. Typical chronic illness issues that lead to early disability/demise include:
- Obesity, highly associated with cardiac conditions, dementia, cancers and debilitating arthritis.
- Congestive heart Failure (CHF); only 50% of individuals live five years or longer with this condition.
- Atrial Fibrillation (AF or A Fib) is often concurrent with CHF and reduces exercise tolerance. Many elderly people are treated with a blood thinner such as Coumadin or some of the newer anticoagulants that are as yet not fully vetted for safety. Blood thinners are particularly problematic in older people, due to inattention regarding testing for blood levels, chronic blood loss through the gut and falls.
- Falls: Dehydration, anemia, sight impairment and over dosage of blood pressure medication are frequently seen in elderly people. One in ten falls leads to an injury, 50% of those injuries results in a hospitalization or surgery, with only 50% of those people unable to return to their previous level of functioning. Falls need to be taken very seriously.
- Cognitive impairment/dementia: loss of hearing and sight, social isolation, mini-strokes and Alzheimer’s disease cause progressive inability to stay safe or perform normal activities of daily living. Any sudden or progressive “change in mental status” should be acted upon by the family so as to prevent further loss of function. There is no treatment or dementia, and no recovery of function.
- Note that diabetes, in later stages, leads to heart attacks, strokes, vision loss, and dementia.
- Once chronic illness and the natural effects of aging are identified, likely scenarios as to how to mitigate the losses or manage the risks can be reviewed and deployed. This aids financial planning, planning for downsizing so as to preserve family assets, and give time to get on wait lists or apply for benefits (e.g. VA benefits, subsidized senior housing, etc.). This process also enables the person and family to emotionally process the very real sense of “loss” (loss of function, role in the family, relationships, social activities, etc.) that comes with aging and chronic illness.
As care managers and health advocates, LifeSpan nurses are often able to assist a “soft landing” for our aging clients and their families, if we have enough time to deploy strategies (too complicated to go into here) to stretch the family assets and entitlements. With the costs of Long Term Care (think $100,000 per year for Assisted Living in New Jersey or $145,000 for a quality nursing home) rising almost exponentially, it is imperative for Baby Boomers to begin to assess their parents near-term needs to assure the family legacy does not become a series of bad memories, lost opportunities and regret.