Talking to Your Loved One About Long-Term Care
Medicare only covers medically necessary care and focuses on medical acute care, such as doctor visits, drugs, and hospital stays. Medicare coverage also focuses on short-term services for conditions that are expected to improve, such as physical therapy to help you regain your function after a fall or stroke.
Medicare does not pay for the largest part of long-term care services. This is the personal supervision that is often called custodial care. Now may be the best time to speak with your loved ones about the realities of planning for a long term care need.
Scenarios You May Be Facing
Q: My parents are refusing to talk. Should I drop it?
A: It’s common for people to resist all this talking. Let them know that’s okay, you understand. But also let them know that you do want to address these issues, that it’s important. Letting them steer this, asking them to talk about their concerns, will help. Be gentle, but persistent. But no, don’t drop it. Believe it or not, most people do eventually open up, at least to some extent, and are relieved when they do. If they really won’t talk, no matter how you try, then talk with other family members and do the best you can to plan.
Q: My brothers and sisters and I don’t agree on how to handle the situation. How do we begin to figure it out?
A: Of course, your parent should be making the decisions. But if he or she is no longer able, then get a professional to settle any debates about your parent’s health, legal situation or finances. For example, sometimes a person in the early stages of dementia can seem perfectly normal when an out-of-town child stops by. The confusion is more apparent to the child who is there regularly. Don’t fight about it; get your parent in for an evaluation and let a medical team explain the problem. If the disagreement is about her living situation, a case manager, social worker or geriatric care manager might help sort things through. If no one has been granted power of attorney, then the child who serves as the primary care giver should have the most say. Often there is no right or wrong answer. Ask yourself if this issue is really more important than your relationship with your sibling. All siblings should have a chance to participate in making plans and providing support.
Q: I want to talk to my parents but don’t want them to think that I’m unwilling to care for them, or that I’m a gold digger.
A: Then tell them exactly that. Be direct. Let them know that you want to be there for them, and that you are not concerned about inheritance. And in case you are eyeing what you might get, and many people do, remember that any money is for your parent’s care, absolutely and completely.
Q: I’ve talked with my parents, but they refuse to take any action. They won’t sign advance directives and they refuse to think about long term care needs. I’m so frustrated!
A: You’re not alone, and your frustration is completely understandable. Their decisions and lack of action may have a big impact on you one day if they are sick and you are left to sort things out. Try different approaches. If you spoke to your parents in person, now try writing a letter. Or get someone else to talk with them. You might find that they are more willing to listen to your brother or uncle. Illustrate what may happen if they don’t plan (decisions will be made for them, they might run out of money, the court might get involved, etc.). Talk to them about how their resistance to plan will affect you and your siblings. You could also make a deal with them. Tell them that if they will just talk to a financial advisor or attorney, then you will stop bothering them. If possible, take a break and let the subject drop for a couple of months, and then revisit it. When you’ve used up all your tricks, back off. They are adults and they have the right to make decisions — or to fail to make decisions — about their lives.