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Talk to relatives about caregiving before they need it; resources that can help

By Michelle Singletary
Thursday, June 3, 2010; A14

Before my grandfather died of cancer, I helped my grandmother care for him in their home. For more than a decade, I managed health care and other financial issues for my disabled brother until his death. I also assisted with some of my grandmother's financial affairs in the years leading up to her passing. I'm currently the trustee for an older aunt.

With this experience, you would think it would be easy to talk to yet another adult about his care. But it's often not easy to get someone who has been living independently to open up, especially about finances.

Gathering the information my husband and I need to care for my father-in-law has been difficult. He is fiercely frugal and private. Everything we mention that he needs -- a wheelchair or assistance with his daily living -- is met with resistance because of the cost. He keeps coming back to two things: He's worried about outliving his money, and he wants to leave an inheritance to his grandchildren.

I certainly understand the first concern. The second point is a wonderful gesture, but we need him to use his money now for his care.

To help with having the all-important conversation about my father-in-law's care and finances, I turned to a professional to get some tips on effectively having the talk.

"We start saving for our kids to go to college years in advance but don't talk to our parents until it's too late to make good decisions," says Rosemarie Rae, executive vice president of strategy for Volunteers of America. She is running the nonprofit organization's "Aging With Options" initiative.

Rae and other professionals urge that you start talking well in advance of when you think you need to start caregiving, when your loved ones are still in good health.

Wait too long and it's hard for your mom and dad to acknowledge their diminishing cognitive abilities or their failing health. Say nothing and it becomes more of a struggle by the time you notice your dad's deteriorating memory or that your mom's house is a mess because she can't clean it like she used to.

So where do you start?

"A great way is by letting your aging parents or relatives know that you want to support them, that they can count on you, but in return they have to help you prepare," Rae says.

I like that conversational strategy. If they expect you to help -- and you should -- they need to make things easier by opening up. Here's a list Rae came up with. It is by no means all-inclusive but will help you get started:

-- Talk about the need for advance directives -- a living will and medical power of attorney. These legal documents will allow an aging parent to designate someone to make health-care decisions and convey end-of-life wishes. Check this Web site for more information: http://www.nlm.nih.gov/medlineplus/advancedirectives.html.

-- Ask about insurance policies including long-term care, disability and life.

-- Discuss all the possible living options should that need arise. The options may include home modifications (to yours or theirs), home care, assisted living, senior day-care centers and nursing homes.

-- Share information you've gotten from your local office of aging. You can find the contact information by going to http://www.eldercare.gov.

-- For added support, consider hiring a geriatric care manager, a professional who specializes in helping families who are caring for older relatives. "When siblings are spread across the country, this person can help you come up with a game plan before something happens," says Kaaren Boothroyd, executive director of the National Association of Professional Geriatric Care Managers. The cost can range from $80 to $200 per hour. But the fee could be more or less depending on where you live. You can find more information on this topic at http://www.caremanager.org.

"Caregivers are rarely prepared for the emotional wear and tear on their marriages and sibling relationships," Rae said. "While caregiving can be rewarding, it can also stir up years of resentments and unresolved family issues. Engaging a neutral third party to negotiate can be very helpful."

-- Discuss what monthly income, savings, investments and other assets the older relative has. Save this topic for the last part of your talk.

Relatives -- adult children included -- can take advantage of seniors, so understand that your parents may be reluctant to hand over financial information. Nonetheless, keep pushing, because in all that you will have to do, it's vital to effective caregiving to have some idea of what financial resources are available. So talk.

Readers can write to Michelle Singletary at The Washington Post, 1150 15th St. NW, Washington, D.C. 20071.

Comments and questions are welcome, but because of the volume of mail, personal responses are not always possible. Please note that comments or questions may be used in a future column, with the writer's name, unless a specific request to do otherwise is indicated.

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