Options of Elder Care

Know when it is time to get extra help 

and which type of care is appropriate 

for your loved one’s needs.

There is an awful lot to be said for an elderly person remaining at home as long as possible [1]. Home is familiar, its the place that holds a lot of treasured memories, and staying at home is key to retaining independence and feeling less like a 'burden' on family members (however inaccurate that feeling may be). However, there may well come a point when home is simply no longer a healthy, safe, or practical option. People who need medically intensive  round the clock care, or are unable to afford the assistance required to keep themselves safe and their homes running efficiently may well be better off if they receive care in a facility setting. This can be a hard decision to make, but there are a few pointers which may make choosing easier.

Struggling With ADLs and IADLs

'ADL' stands for Activities of Daily Living [5]. These activities include ambulation, bathing, continence, dressing and grooming, eating and toileting.  The ability to manage these activities is necessary to live independently.  IADL means Instrumental Activities of Daily Living and they include doing housework and laundry, shopping and preparing meals, managing medications, money and caring for pets, as well as other basic functions which supplement independent living. As people age they lose the ability to perform these activities as they used to.  Inability to perform ADLs and IADLs are usually the sign that assistance is necessary. Most elderly will maintain a degree of function with their ADLs and IADLs and can often still live quite happily in their own homes with a greater or lesser amount of outside assistance. However, when functionality of these activities drop significantly, then it's considered a sign that your loved one should make some changes so their care needs can be met on a more permanent and professional level.

Home Health Care Option

Staying at home for as long as possible is usually a very good idea. Many elderly prefer to stay at home and will refuse to move despite their need for increased daily care with their ADLs and IADLs.  Moving elderly people away from the comfort and familiarity of home can be very distressing, which in turn can affect their health. For such people, home health care is probably the best option. Home Health care can help your ageing loved one maintain their treasured independence and stay safe in the comfort of their own home. 

With home health care medically trained Caregivers come to the home and provide the individualized care that the elderly person needs. Home health care can be very flexible and provide as little as an occasional visit every two weeks to tidy up the house to round the clock care daily care.  In some cases with the help of home health care, it is possible to remain at home long term and receive appropriate care which includes hospice and end of life care.  The home health Caregiver forms a unique bond with their home patients and in many cases, become part of the family. The elderly person receiving care has dependable care that is tailored to their preferences.  Not only does this keep them feeling comfortable and safe at home, but it also allows them to maintain their independence which is indescribably valuable to the elderly.

Assisted Living Option

The hardest part of sending a parent or loved one to a facility setting can be persuading them that it's the right thing to do. Often they just don't want to go, and it's not unusual for distressing scenes to develop [3]. On these occasions, it may be a good idea to look at assisted living options. In most assisted living situations the facility is set up to feel like home.  The buildings have individual rooms which Residents can decorate with personal items from home.  There are common living areas which promote socialization among all the elderly who live there.  It may not be home, but assisted living facilities try to maintain a home-like atmosphere while providing the care that an elderly person needs. 

When looking at assisted living facility, also known as a CBRF, Community Based Residential Facility, it is best to remember that there are many types of facilities which offer different degrees of care.  It is wise to ask about the facility’s state classification to get a clear idea of what degree of care they are allowed to provide.  Some facilities provide limited care and assistance while others can provide full health care on site, including up to end of life care.  Choosing a facility according to its location and decor is often short sighted as your loved one’s care needs will increase and that may mean having to change facilities in the future. 

Nursing Home Option

If your loved one has an acute health condition, a nursing home may be the best option. When an elderly person requires care which isn't feasible to manage at home with home health care, or is beyond the scope of care for an assisted living facility, then a stay in a nursing home might be the best option. Typically a nursing home has a more institutional atmosphere as the focus in health care rather than just assisting with ADLs and IADLs. 

The bottom line is, if your loved one is seriously struggling to manage their ADLs and IADLs in their own home, and their quality of life is declining as a consequence, then it is time to start considering the various options.  Care solutions can be found in many locations, even at home, but matching the type of care to your loved one’s needs requires some thought and planning. Remember the goal is to ensure that your loved one is safe and can enjoy a rewarding quality of life no matter which option is chosen.  

www.homeaidhealthcare.com

www.prairiehomeassistedliving.com

Mel Higham is a writer and editor with a special interest in mental health and wellness.  As a guest writer for HomeAid Health Care’s Elder Topics, Mel brings her expertise to our audience.

HomeAid is sister company to Prairie Home Assisted Living which has served the physical, spiritual, mental and health needs of their residents since 1999. Together the two companies provide comprehensive care for the elderly in the Fox Valley area of Wisconsin.

[1] National Institute On Aging, "There's No Place Like Home - For Growing Old", 

[2] Council On The Ageing, Victoria, "The Voice of older people on Independence", 2009

[3] Carol Bradley Bursack, "Handling a Parent Who Doesn't Want to Live in A Nursing Home",AgingCare.com

[4] KwikMed, "20 Truly Exceptional Elderly Care Sites"

[5] PBS, "Checklist Of Activities Of Daily Living (ADL)"

[6] Alzheimer's Association, "Choosing a Care Facility"

Sibling Troubles Revived

Caring for aging parents can revive

relationship troubles between siblings.

You grew up together.  You learned, played and fought together as children and were the best of friends and the worst of enemies all at the same time. You know your brothers and sisters well but now that your aging parents need their children to actively help them, you may find working with your siblings to be far more difficult than you ever imagined.

Martha‘s mother recently passed away.  When looking back at the whole experience, Martha could say she was now at peace with it but deeply regretted the relationship damage that took place with her brother and sisters during the months leading up to her mother’s death.  Conflicts over large and small issues drove a deep wedge between the siblings.  There was bickering over medications and doctor appointments.  There was squabbling over spending time with mom.  There was quarreling over who was to help with specific tasks.  There were out and out fights over expenses. It was like all the adults in the family reverted back to childhood battle lines and no one was fighting fair.

United in crisis

Ideally, siblings will unite and work together to care for their parents when they are ill or become too frail to care for themselves.  Yet in real life it is often a crisis that suddenly forces siblings to unite to provide care for an aging loved one.   These crisis situations trigger a lot of family friction.   Conflicts are made worse by brother and sister’s fine-tuned ability to push each other buttons and relive childhood rivalries.  Arguments over care sap the strength out of the family at the time when their parents need them to work together.  It is also very upsetting to the aging parents who depend on their children for help. 

To avoid conflicts siblings need to face the fact early on that they will someday be called on to care for their aging parents.  Preventing disputes over how best to provide that care is ideally done long before any care is needed.  Sitting down with parents before any care issues arise and discussing the realities of aging is the first step to keeping the family intact and working together through the care years later on.

Talk it out ahead of time

Long before the need exists, when the adult children are in their 40’s and the aging parents are roughly in their early 70’s, have a serious talk about the future.  Gather the family and openly discuss the possible scenarios of the parent’s future care needs.  It may feel premature and a bit morbid to discuss your loved one’s mortality, but it is foolish to pretend they will not age or face health issues someday.  Most people avoid this uncomfortable discussion and wait until a crisis forces the issue and then they must make quick decisions which often lead to mistakes, conflicts and frustration.  It is wise to talk about the parent’s wishes and how they could be honored so the entire family has a framework for the future.  Having a general care plan in place will go a long way if a crisis hits and also will serve to lay the ground work for future long term care. 

Figure out who will do what

Recognizing off the bat that the division of labor will never be perfectly fair, discuss among the siblings who could do which tasks and how much money each would be willing to pitch in to pay for care if necessary.  Try to roughly divide up the responsibilities according to ability.  Sketch out a game plan that all members of the family can theoretically agree to. Don’t assume that since you were all raised in the same family that you naturally agree on what is best for mom and dad.  There will be some emotionally intense moments when you will not agree at all and these will test your bond as siblings, so try to define roles and rules ahead of time to ward off extra conflict.

Gather all the important documents

The sibling(s) with strong organizational and finance skills should be appointed the Power of Attorney for finances by the parents.  Everyone in the family should have a clear understanding of under what situations that power would be activated and what tasks the Power of Attorney will take care of.  This sibling should know where all the money and accounts are kept as well as all the insurance and investment paperwork. Once activated, the POA of finance should gather the titles to the house and cars, safety deposit boxes, keys and passwords for all accounts. They should review any long term care insurance and all other insurance policies your parents have set up and understand the fine print about what is covered and how it will be covered.  The sibling in charge of finances will take care of organizing all the important paperwork, arrange the payments for all bills and should keep the rest of the family informed.  The POA of finances will become knowledgeable about their parent’s financial details and be able to manage the available money to cover care and end of life costs.  They will be responsible for exploring public assistance options if the funds run short. 

Health Care Decisions

As parents age, their health care becomes an increasing concern.  From managing their medications and doctor appointments, to helping with mild cognitive issues to working out end of life care, the amount of decisions can be overwhelming.  The sibling who has been appointed POA of health care will have their hands full once their power has been activated.  If the aging parents were clear about their health care directives and where they wish to be when full time care is needed, then the many decisions will not be such a major source of stress.  Yet even with clear guidelines in place there will be many health care issues where conflicting opinions between siblings cause stain.  One family set a rule that the sibling present at the moment gets to make the decision and, once made, it cannot be second guessed.  Even though all agreed to this rule in the beginning, the siblings found it quite difficult to abide by.  Again, it is having a clear understanding of the roles and rules between siblings that make the care years easier to manage. 

With long term family ties, a little grace will go a long way, especially when stressful situations demand a unified working cooperation.  Know ahead of time that all decisions regarding the aging loved ones will not be unanimously accepted but agree to disagree nicely for the sake of the parents and future family relationships. 

www.homeaidhealthcare.com

www.prairiehomeassistedliving.com

Kate McCarthy is Director of Operations for HomeAid Health Care which provides services for the elderly who wish to remain safe and independent at home.  HomeAid is sister company to Prairie Home Assisted Living which has served the physical, spiritual, mental and health needs of their residents since 1999.  Together the two companies provide comprehensive care for the elderly in the Fox Valley area of Wisconsin.

What you need to know when you are the family Caregiver

Knowing what to expect can make it easier.

Providing care for an elderly loved one feels like the right thing to do.  Often family members grow into the role of Caregiver as their aging parents need more and more help.  A bit of yard work in the fall, help with spring cleaning, driving to doctor appointments and weekly trips to the supermarket are easy to accommodate and most families are happy to have the opportunity to help.   It is when the need for help becomes daily or reaches a point when your elderly loved one isn’t safe living on their own any longer, that families need to make some hard decisions.  Families will often slide into becoming their loved one’s full time Caregiver and then they find themselves providing care for their own young family and their aging parents. 

The Sandwich Generation

A term coined by Carol Abaya in the early 1990’s, the Sandwich Generation describes those in their 50s or 60s who are sandwiched providing care for their aging parents and their adult children and grandchildren. It is a challenging time period for these people as they have demands on their energy and resources from everyone in their family.  Many start out enthusiastic and excited about being able to give back to the one who had raised them, only to become burned out and bitterly disappointed at how their relationships, quality of life and energy levels have been destroyed.

For those who decide to take on the many responsibilities and demands of becoming the Caregiver for their aging loved ones, there are some basic tips which might make providing care easier

Know that you will have to make hard choices

Many don’t realize when they start out as family Caregivers that they are now have taken on the responsibility to make another person’s decisions.  Many times this makes the Caregiver the least favorite person in the family.  Having to decide on an endless list of health care issues, finances and quality of life decisions can be exhausting, but it is often compounded by your loved one not agreeing with what you think is best.  Siblings often add their 2 cents, making basic decisions a multi-leveled negotiation. Many elderly will resist getting input into major decisions believing their independence is being infringed on.  Often they are slow to consider the options and will put making any type of choice permanently on hold.  It is frustrating for those who provide care to be patient and respectful especially when deadlines are looming.

It is wise to have major decisions already determined before they become an issue.  Sit down with your aging loved one and discuss how they want their affairs handled long before they can no longer manage themselves.  Your loved ones can set up directives early which will take the pressure off of you to decide for them later in life.  Life is much easier when medical directives are in place, the will has been made, Power of Attorney for finances and health are set up and end-of-life choices have been decided.

Know that caring for an elderly parent is not like caring for a child

Remember that your aging loved one has lived an entire life before you even came into existence, so treating them as if they were another child is disrespectful and demeaning.  Expect there will be times when their behavior is as stubborn as a toddler’s, but do not respond as you would to a child.  Instead try to find out what is going on and give them the time to discuss their concerns and fears.  Do not expect your loved one to easily adapt to your schedule and ways of doing things.  They are probably pretty set in their ways and have every right to be so.  Also remember that they crave adult interaction and need to be included in your family’s normal life and activities, even if doing so requires a lot of extra effort on your part.  The last thing you want is to have them feel as if their presence is a burden and that they are isolated and lonely and just taking up space in your home.

Know that providing care can be uncomfortably embarrassing

Understand that as your loved ones continue to age, their need for assistance with personal care will increase.  This can cause embarrassment for both generations.  Helping with showering, dressing and toileting can be weird for the adult children of aging parents, but after a few times it will feel less awkward.  Trouble with incontinence and loss of body functions can make everyone cringe and for some it is just easier on relationships to have a professional Caregiver come in a couple times a week to help with personal cares.

Know that providing care will affect your other relationships

Being a Caregiver is a very demanding job.  It requires a servant’s heart at all times and usually without any recognition or thanks.  Most often it is the women in the family who take on this role in addition to all their other duties and responsibilities.  Being stretched to the limit, the family Caregiver will find relationships on all sides bearing the brunt of frustrations, exhaustion and weariness. Interaction between the aging parents and adult children can become strained, as well relationships with everyone else in the family.  People often imagine having multiple generations under the same roof will be wonderful, especially for the younger children.  They fail to realize that the aging have limited tolerance for noise and commotion and would prefer some space from the younger members of the family. 

Know that doctors are interested in prolonging life, not the quality of life

Doctors will be a primary source of information and help as your loved one’s health needs increase.  They are kind, caring and committed to your loved one’s well being, but their main concern is dealing with the physical concerns that prolong life.   This most likely will result in more and more prescriptions for medications, endless office visits and lots of tests.  As the family Caregiver, your job will be to facilitate the doctor orders, to manage the medications and interface between physicians.   It will fall on you to become your loved one’s advocate for health care concerns.  Yet your primary concern should be about making the final years and months comfortable and enjoyable.  Most elderly are far more concerned about quality of life over longevity and if often falls on the family Caregiver to ensure the quality of life through social interaction, conversation, easy projects and just being there to listen. 

Know that you will need help

Being a family Caregiver can be difficult and stressful, especially when providing care for an aging loved one is sandwiched in with all the other demands of life.  While in the midst of providing care, life can get so busy that it is difficult to see the toll that it takes on your energy, relationships and family.  Most families eventually realize that they need help.  Finding a professional Caregiver to come into the home a couple times a week makes an enormous difference.  Respite Care is another option that allows family Caregiver to get away and unwind. 

Families often naively believe that they can provide care for their aging loved ones with minimal stress or stain on their lives.  Since the end goal is enjoying a close and loving relationship with their aging loved ones, knowing what to expect can make it easier to avoid stressful problems for the entire family. 

www.homeaidhealthcare.com

www.prairiehomeassistedliving.com

Kate McCarthy is Director of Operations for HomeAid Health Care which provides services for the elderly who wish to remain safe and independent at home.  HomeAid is sister company to Prairie Home Assisted Living which has served the physical, spiritual, mental and health needs of their residents since 1999.  Together the two companies provide comprehensive care for the elderly in the Fox Valley area of Wisconsin.

Working Through Grief With Dementia

A person with dementia may not remember the name 

of their missing loved one but still deeply feel that loss in their lives.

We all experience grief. Unfortunately, at one time or another everyone will suffer a loss of someone dear to them. Although people grieve in different ways depending on the nature of their relationships and their past experiences with loss, the grieving process is quite normal and necessary. Grieving helps an individual adapt and accept the reality of their loss, work through the pain and adjust to all the life changes caused by the death of their loved one.

Going through the grieving process is very difficult for people in general; but for people with dementia, the process can be far more complicated. People with dementia experience grief, but their reaction to their loss is largely affected by their own cognitive understanding of what has happened to their loved one, the connection they had with the person they are grieving for and how well they can express their sorrow.

It is wrong to assume that because a person cannot remember the name of their missing loved one they do not feel that loss in their lives. Those with dementia generally live with feelings that things are not right, or a constant state of “wrong-being,” but are usually unable to put their finger on what the problem is. Most individuals suffering with dementia are somewhat aware of their confusion and live with grief over lost abilities, memories and understanding. Add in the loss of someone dear to them and their confusion can be compounded. Grief and the mourning process can be experienced by those with even advanced dementia, regardless of their cognitive ability to resolve or make sense of their feelings. So in most cases it is better to share the news of a death than to try to pretend nothing has changed.

There are several considerations to keep in mind when helping a bereaved person with dementia work through grief.

Choose carefully when to share bad news

According to Melanie Bunn, RN and Alzheimer’s training consultant, consideration must be given to the bereaved person’s cognitive condition when choosing when to share the news of a loss. Select a time of day when the bereaved is rested and feels comfortable and safe. Many people suffering from “sundowners,” a type of dementia, find late afternoons and evenings especially challenging and would be better able to process difficult news in the morning hours.

Choose carefully how to share bad news

Have a familiar and trusted person talk to the bereaved in a clear, calm and simple manner. It is best to have only one person relay the news of a death. People with dementia can be deeply affected by the emotional climate of grieving family members and respond with increased agitation and restlessness. Experts advise avoiding abstract phrases like “passed away.” It is much more effective to plainly state that the person “died.” Keep sentences short and do not overwhelm the bereaved person with dementia with too much information at once. Be prepared to frequently repeat the information as they will need time and repetition to process it. Do not be surprised by a delayed reaction or lack of response.

Help the immediate grief process

Those suffering from dementia can benefit by participating in the rituals of death. According to the article, “Sharing Bad News,” by Melanie Bunn, it may be necessary to modify rituals to make them more workable for the person with dementia. She suggests private visitations rather than participating in public gatherings, attending the funeral but not the burial or hosting a local memorial ceremony rather than traveling great distances to attend a funeral.

After the funeral, it is helpful for the individual suffering from dementia to reminisce about their loved one. Talking about memories while looking at a photo of the deceased will aid in the grieving process. Often the person with dementia needs help expressing their grief and speaking to them using empathetic phrases will help them verbalize their mourning. According to Alzheimer Scotland’s article, “Loss and bereavement in people with dementia,” phrases like, “You sound like you really miss him. Tell me what you miss about him most.” aid those who have a hard time finding words to express the emotions they feel.

Help with long-term grief  

Constant assessment of the cognitive state of the bereaved is very important. Ignoring the mood of the day and trying to force a person with dementia to understand a death can be detrimental to the grieving process. Try to have all people in contact with the person diagnosed with dementia be consistent and patient as they work through their grief over time.

By focusing on the person with dementia and validating their emotions, even though the source of the emotions are lost to them, the grieving process will be made easier for the person suffering from dementia and the entire family.

www.homeaidhealthcare.com

www.prairiehomeassistedliving.com

Kate McCarthy is Director of Operations for HomeAid Health Care which provides non-medical home services for the elderly who wish to remain safe and independent at home. HomeAid is a sister company to Prairie Home Assisted Living which has served the physical, spiritual, mental and health needs of their residents since 1999. Together the two companies provide comprehensive care that meets the needs of the elderly in the Fox Valley.

Sources:

“Sharing Bad News” by Melanie Bunn

“Loss & Bereavement in People with Dementia” by Alzheimer Scotland

“Grief and Dementia” by Kenneth J. Doka

Choose well – Avoid common mistakes with Assisted Living

Choosing an assisted living facility

should not be done in panic mode.

It happens all the time.  A crisis takes place, an accident, a fall or an illness forces the issue to the forefront.  No one in the family had a real plan on what to do when Mom or Dad needed help on a daily basis and suddenly decisions have to be made and have to be made now.  In a panic to find an immediate solution, siblings debate care options and charge out to tour facilities.  In the rush to find a place, often very basic questions are not asked and future possibilities are not considered.  Knowing how to prepare, what questions to ask and what to look for can save your aging loved ones and the entire family a lot of heartache down the road.  Here are some common mistakes to avoid.

Not having the conversation

It is unfortunate that most families get caught off guard about their aging loved one’s future care needs.  The practical decisions of providing care, in most families, have not been clearly mapped out ahead of time so everyone knows what to expect.  This often leaves the adult children in the family in conflict with each other and scrambling to find a care solution when their aging parent suddenly needs daily help.  Wise seniors and their families will realize that it is better to have a plan in place than go through the rush and stress of making a major life decision in panic mode.

Have the conversation ahead of time and get a clear plan set down that the entire family can work with.   Do the research now and make general decisions about how care will be provided once needed.  Create a short list of facilities and service providers to turn to in the future.  Organize a list of things to be taken and things to be passed along to family members when the time comes to move.  Discuss parent preferences of who in the family will take on managing the finances and who will make care decisions in case they can’t.  Get the legal paperwork set up so it is just a matter of activating the decision once the time is right.  These are serious and often uncomfortable issues that all families with aging parents must deal with and putting off having the conversation and making decisions is being short sighted.

Not being realistic about the future

When shopping for a care facility it is important to be realistic about current and future care needs.  Most families look at an assisted living facility with an eye on location, cleanliness, decor and activities but fail to consider if the facility can provide the level of care needed for possible future health and cognitive issues.  Assisted living facilities are strictly regulated by state governments and fall into different categories which determine what level of health care they are allowed to provide.  For example in the State of Wisconsin, there are three different levels of assisted living facilities: community-based residential facilities (CBRF), adult family homes (AFH) and residential care apartment complexes (RCAC).  Out of these three categories only CBRF facilities can provide significant health care on site. In addition, within the CBRF category there are various classifications which determine who they can and cannot serve.  Pay attention to the facility’s classification and ask specific questions on if they provide up to end of life care as well as if and when they would ever require a Resident to move.

As the elder ages and health needs change, some facilities will be forced to evict Residents when they no longer can provide the level of care required. So it is important to consider future decline in health and cognitive abilities when choosing an assisted living facility.  Moving a loved one from facility to facility is costly as well as emotionally and physically difficult for the elder so it is better to be realistic about the future care needs now.

Not understanding the fine print

Even though moving into an assisted living facility is usually a health care decision rather than a real estate decision, there will still be contracts involved.  Most facilities have straightforward contracts which need to be read in detail.  When choosing between facilities, one of the main sources of confusion is the various pricing structures which should be explained in detail in the contract.  In addition to admission fees, facilities will have diverse systems set up to determine monthly costs.  Some facilities have base rates for room rental and meals and then charge extra fees for cares.  Others may charge for each service provided a la carte or they may rank the level of care needed on a sliding scale and increase the monthly charges according to how many cares the person needs.  With a scale system, Residents start at a lower cost but should expect monthly rates to increase as care needs increase.  Other facilities lock a rate at admission and will honor that rate regardless of increase of care needs due to aging, only to address the fees again if there is a major change in health. Since each assisted living community sets up rates differently, it is important to understand and compare upfront costs and how they may change over time.

Knowing about these common pitfalls can save the entire family stress and regret and allows everyone to focus on making the transition to an assisted living facility easier for your loved one when the time comes.

www.homeaidhealthcare.com

www.prairiehomeassistedliving.com

Kate McCarthy is Director of Operations for HomeAid Health Care which provides services for the elderly and disabled who wish to remain safe and independent at home.  HomeAid is sister company to Prairie Home Assisted Living (Class C, CBRF) which has served the physical, spiritual, mental and health needs of their Residents since 1999.  Together the two family owned companies provide comprehensive care for the elderly and disabled in the Fox Valley of Wisconsin.

Estate Planning Tasks – Get It Done List

Having your affairs in order is a blessing

you leave to your loved ones.

Many people dread the paperwork involved with planning their estate.  It seems like a dreary and difficult task that really should be done, but is often is left for later.  Yet not doing it creates a horrible mess of red tape, court procedures and could result in the government making decisions about your possessions for you.  Not having your estate established is time consuming and often upsetting for your loved ones and can cause friction in your family after you are gone.  Getting your estate taken care of ahead of time is the responsible and loving thing you can right now do for your family.

There are only a few essential documents you need to tackle to get your affairs in order.  Getting the details tidied up now will free your loved ones from major hassles and headaches down the road.  

Estate Planning To Do List:

ü Last Will and Testament

 Making a will allows you to decide what happens with your children, possessions and property.  Items of financial or sentimental value can be distributed as you see fit in a will.  You can name guardians for those you provide care for, such as children or pets, as well as designate assets you are leaving behind to provide for their care. You can also state your preferences for burial and leave behind special instructions.  Without a will a probate court will make these decisions for you and whatever the court decides will be a matter of public record. 

It is important that each spouse in a marriage has their own will.  It is also important to update your will whenever any big life changes occur, such as marriage, divorce, birth of a child or purchase of real estate.  Moving to a new state means the will may need to be renewed. 

It is just as easy to make a new will as it is to change an old one and often it is less confusing than sorting through a series of codicils.  Getting an attorney to help is important if there are substantial assets or a legally complicated situation, but for most people it should be a straight forward task that is easy to check off the list.

ü Durable Power of Attorney

In the case that you can’t make your own legal and financial decisions it is important to have chosen someone to act on your behalf.  Many elderly put this one off out of fear of losing their independence and control over their decisions. Yet not taking care of this simple task causes major problems your family if you are incapacitated.  Your family cannot make legal decisions for you without an established POA. LawDepot has free power of attorney forms available which work in each state.

In the case that you do not have someone you trust with the responsibility of being your POA, a limited power of attorney can be established with a probate court monitoring all decisions made through a guardianship or conservatorship.

Note that some banking institutions don’t accept a general power of attorney document and will require you to fill out their own forms.  

For many people establishing power of attorney is as useful as establishing a will and needs to be one of the first things to tick off your list.

ü Revocable Living Trust

A living trust is another way to pass on assets to your loved ones and avoid the expense and frustration of probate.  This tool allows you to name a trustee to manage your property.  A trust differs from a will in that your property can be distributed before your death and it can be used to provide a savings on taxes.  Learn more about the differences between will and trusts.  A revocable trust is given that name because you can change it as long as you are mentally competent.  A trust is bit trickier than a will, especially if there is substantial property or wealth, and requires an attorney’s help to get it checked off the list.

ü Beneficiary Designations  

Life insurance, retirement plans and bank accounts all ask for a beneficiary to be named to inherit the proceeds in the case of death.  It is important to be crystal clear about the who you want to benefit from these assets as the designation you make take precedence over any instructions you have left in a will.  Keep the beneficiary designation paperwork with your estate planning documents and be sure to review and update them with any life changes that occur.

ü Health Care Power of Attorney and Living Will

When establishing a health care power of attorney, you name a person to make medical decisions on your behalf in the case that you are incapacitated.  It is different from the durable power of attorney which deals with legal and financial matters. 

With a living will you can state ahead of time what types of care you want and don’t want in the case that you can’t communicate.  A combination of a living will and health care power of attorney allow you to share your wishes in an advance directive form.  Making these types of decisions requires a lot of thought and the American Bar Association has put together a tool kit to help sort these decisions and create an Advance Care Plan that is right for you.  Remember that each state has its own requirements so established plans may have to be revisited if you move. Checking both of these items off your list means you can rest assured that there will be no confusion regarding your health care preferences and directives.

ü Letter of Intent

Special instructions, requests or the sharing of personal and financial information that typically does not go into a will can be recorded in a letter of intent.  It is used to convey hopes and wishes you have which are not mandatory.  A good example would be your instructions on how you want the funeral or memorial service to be organized or your preference on where to hang a painting bequeathed in the will.  This letter does not carry the legal clout of a will but is a good way to pass on private information which should not be a matter of public record. 

Got it done!  Now where to put it?

It is very important that your family knows where to find all the documents you have prepared.  Make a master list of all the documents so your representative knows what should be there.  Include all important papers for life insurance, annuities, pension or retirement accounts, and bank accounts, family records including divorce, birth and adoption certificates.  Don’t forget to include real estate deeds and any stocks, bonds or mutual funds you have.  Another thing to add to your paperwork is a list of bills and accounts, with all the contact information, so it is easy for your representative to close all accounts and settle any final bills.

Once you have all these documents gathered and completed then it is a question of where to store them.  A safe at home is probably your best bet but some lawyers can take care of your estate documents for you.  Be sure to check the laws before putting them into a safe deposit box at a bank. Some states and local probate laws will require that safe deposit boxes are sealed at time of death which would complicate things and make useless all your efforts to organize your estate ahead of time.

www.homeaidhealthcare.com

www.prairiehomeassistedliving.com

Kate McCarthy is Director of Operations for HomeAid Health Care which provides services for the elderly who wish to remain safe and independent at home.  HomeAid is sister company to Prairie Home Assisted Living which has served the physical, spiritual, mental and health needs of their Residents since 1999.  Together the two family owned companies provide comprehensive care for the elderly in the Fox Valley of Wisconsin.

Sources:

“Estate Planning Documents You Need Right Now” by Marilyn Lewis. www.moneytalksnews.com  Retrieved 5/19/14.

“8 Essential Estate Planning Documents” by Gerry W. Beyer.  www.lawprofessors.typepad.com Retrieved 5/20/14.