The Dignified Aging Toolbox
By Laura Nichols, J.D.
Most of us would agree with the late Andy Rooney: the idea of living a long life appeals to everyone, but the idea of getting old appeals to no one. Given that aging is enviable and most of us wish to age with dignity, being prepared is key to ensuring that our senior years are safe, comfortable, happy and dignified.
In my practice as an estate planning attorney, I meet many families who want the best for their loved ones and themselves in the senior years but are unsure how to plan for that outcome. To help provide a toolbox of the information and resources we all need to age with dignity, I recently assembled and moderated a panel of professionals to talk about the various aspects of the “planning for aging” process. Below is a summary of our discussion.
Addressing the Topic of Aging
Often, the biggest challenge is simply beginning the conversation with a loved one about the future. Aging is a difficult, sensitive topic and can be especially hard for children to address with their parents. According to Dr. Daniel Sewell, a professor of clinical psychiatry and Associate Vice Chair for Development and Geriatric Psychiatry at the University of California San Diego, how you broach the topic isn’t as important as just doing it. Your goal should be to listen to your loved one’s priorities – paying attention to non-verbal cues as well as spoken words - and assure them that your goal is to develop a plan to ensure that those priorities are met.
Emotions can affect and occasionally undermine the planning process, so you should strive to be patient and calm during your discussions. If emotions begin to run too high or the family history we all have creates a minefield, consider bringing in a neutral third party to capture the intent. Documenting all decisions and considerations is critical to ensure that everyone is clear on priorities and goals at all stages.
Establishing Your Team
One of the first things we should do is determine who will have power of attorney and/or be a decision maker. Dr. Rebecca Montano, an aging life care manager and eldercare mediator, suggests that seniors choose someone who is likely to survive them and will follow their wishes. She also recommends that individuals write and/or record a quality of life statement clearly expressing their wishes and priorities. It is important that loved ones hear your words and have something tangible to refer to if decisions must be made. Dr. Montano also suggested you establish a partnership or team of people who will assist you as you age. This team might include a lawyer, physicians, family members and caregivers.
From a legal perspective, I suggest everyone - regardless of age – establish the following documents:
- A Financial Power of Attorney for Asset Management
- Trust and Pour Over Will
- Advance Health Care Directive
- HIPAA Authorization
When asked “When should I have these?”, my answer is “The sooner, the better.”
Dealing with Insurance and the Rising Cost of Care
Financial Advisor and Certified Long-Term Care Specialist Tyler Nichols stresses the importance of obtaining long-term care insurance as soon as possible, as we all are “one doctor’s appointment away from being declined.”
Mr. Nichols suggests the “3 Cs” when shopping for long-term care:
- Carrier: Go with a solid carrier with a high strength rating and never go below an A+ rating.
- Cost: Be aware of the cost and don’t deviate from your budget.
- Contract: Pay attention to the fine print including the specifics of what is actually covered and paid by the carrier and the time period before the coverage is triggered.
In addition to insurance and paying for care with savings, 1035 Exchanges and health savings accounts are also options. While there may be government benefits available, there is still a gap between such benefits and the actual cost of care.
Knowing When to Move
Leaving a beloved home can be one of the most difficult aspects of aging. The desire to live in one’s home can last longer than the practicalities of doing so. According to Bryan Devore, a realtor who specializes in helping seniors with their real estate decisions, it is important to plan ahead, and evaluate your wants and needs of a home in the future as well as the present. While moving to a new home can be difficult, living in a place where most or all of the items on your checklist are met is always as better than staying in a home that is lacking.
Dr. Sewell recommends that families avoid promising their loved one they will never be moved into a nursing home. It is an unrealistic promise, and, in many cases, at some point such a facility may be the best place for an aging or ill senior. If you have already made the promise not to move someone, don’t feel you must be held to it. Dr. Sewell encourages family members to acknowledge the promise and then explain that circumstances have changed, and the move is now the best decision for the loved one.
Knowing Where to Move
While some seniors choose to stay in their homes, many are enjoying the benefits of community living. Often similar to resort- or cruise ship-living, senior communities can offer access to social, emotional, spiritual and physical support, as well as other benefits seniors can’t get by living on their own. According to Bobi Thomas, directive of sales and marketing for a San Diego senior community, one of the greatest advantages of community living is the staff or team who can help track your status as you age and offer a continuum of care.
If moving to a community, Ms. Thomas suggests you do the following:
- Ask what the cost is now and what is included. Also ask what the highest cost might be as care needs change in the future.
- Learn what type of training the care team has and about the longevity of the staff.
- Schedule a tour then come back twice at unscheduled, different times of day.
- Observe if the staff interacts with the residents and guests.
- Examine the building and facilities to ensure the upkeep is good.
Managing the Practical and Emotional Aspects of Moving
Moving to a shared community most likely involves downsizing. Jami Shapiro, founder of a senior move company, stresses the importance of developing a realistic sense of what life will be like in the new space and planning accordingly. Coming to terms with choosing the essentials and not trying to take everything with you can be emotionally and physically draining, but necessary.
The process of moving is so difficult that there is an actual medical diagnosis called Relocation Stress Syndrome, characterized by anxiety, confusion and loneliness. Dr. Sewell acknowledges that an individual’s grief can be acute when they leave their home. The best way to help is to validate feelings. Unexpressed emotions can be a roadblock to an easy transition, so allowing the individual time to “act out” and think it through is important.
Ask for Help
During my years of working with clients and their families through all stages of their journeys, I have seen firsthand how difficult discussing and planning for aging can be for all concerned. It’s important to note that it isn’t an experience you and your family need to go through alone. There are many professionals who specialize in helping families and are ready and willing to be tools in your toolbox. I encourage you to reach out and ask for help.
Laura Nichols is Of Counsel with the San Diego-based law firm Seltzer Caplan McMahon Vitek. She is a Certified Specialist in Estate Planning, Trust & Probate Law by the State Bar of California Board of Legal Specialization and is also certified as an Accredited Estate Planner® by the National Association of Estate Planners & Councils. Her practice is focused on estate planning, trust and estate administrations, family and business planning, and charitable planned giving. Ms. Nichols is a frequent speaker, is currently serving as Past-President of the Estate Planning Council of San Diego and was recently named one of San Diego’s Top 40 Under 40.