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Taking Care of Mom and Dad: Your Mom and Dad Need Help...Now What?

The theory of unintended consequences holds that the manner in which a good thing is achieved can sometimes lead to a bad outcome...or several bad outcomes.

If you ever needed proof that unintended consequences are real, look no further than your parents. If you are an average American, they are still living -- and will probably be with you for many years to come. That's good. And you should appreciate that good in all of your interactions with your parents.

What is the unintended consequence? The happy fact your mom and dad are still alive is threatening the solvency of America's main social welfare programs.

In 1900, the average life expectancy was 47 years; in 2000, it was 77 years. That's the fastest and largest increase in the world's history. It's dramatically changing the demographics of the United States. You've probably heard about the rising political clout of groups like the American Association of Retired Persons (although that group has dropped "Retired" from its name and goes with the simpler acronym AARP).

But the effects are more than political. And the statistics are, frankly, staggering:

  • In 2002, more than 77 million Americans were over the age of 50; 35 million were over 65; and 4 million were over 85. Many of these people will be living into their 80s and 90s, often with chronic illnesses.
  • The average life expectancy for an American woman turning 65 in 2002 is age 84; for a man, age 81.
  • Some 44 percent of American adults are caring for both elderly parents and minor children. Almost half of those said they should be doing more for their parents.
  • There is virtually no government assistance for those who prefer to keep their elderly relatives at home. According to a 2001 AARP study, 27 percent of caregivers between 45 and 55 help pay expenses for older family members.
  • As many as one in four American households now is involved in caring for an older adult, with the average caregiver devoting 18 hours a week to patient care, according to the National Alliance for Caregiving (NAC).
  • Caregiving costs the givers upward of $659,000 over a lifetime in lost wages, Social Security and pension contributions, according to a MetLife study.
  • Of the caregivers studied by MetLife, 84 percent made adjustments to their work schedules by taking sick leave or vacation time, decreasing work hours, switching from full- to part-time employment, resigning or retiring.
  • A survey by the Family Caregiver Alliance (FCA), a California nonprofit that helps family members navigate the el-der-care system, found that 18 percent of people helping to care for an elderly relative had quit their job to provide care, and 42 percent had reduced their work hours.
  • According to the FCA, of the $127 billion spent on elder care in 1998, $78 billion came from private pockets -- versus $34 billion from federal and state coffers.
  • The Centers for Disease Control reported that 82 percent of seniors admitted to nursing homes each year do not come from a family member's home. In other words, families are relying on institutional care as a default solution.
  • A nationwide study released by the Alzheimer's Association estimated that 64 percent of those providing care to people with Alzheimer's disease are in the work force.
  • According to a study sponsored by the National Alliance for Caregiving and AARP, 54 million Americans -- threequarters of them women -- are involved in caring for a parent, a spouse, a sibling or a disabled child.
  • According to a study by the U.S. House of Representatives, the average woman spends 17 years caring for a child and 18 years caring for her elderly parents.
  • A survey of about 500 U.S. employers found that 21 percent offered elder care referral services in 2002 versus 15 percent in 1998.
  • All of these statistics will grow dramatically some time around 2010, when the first wave of the huge baby boom generation hits age 65.

You're reading this book because these statistics have hit home for you. The aging population isn't about demographics anymore; it's about your mom or dad needing your help...now. And you're not sure about what to do.

What you'll find in the 13 chapters that follow is a detailed discussion of what you can do to help your parents most effectively. I've organized the discussion in two parts: the first deals with how you can get the most for your parents out of private insurance, pensions and retirement accounts, government programs and other benefits; the second focuses on the physical, emotional and family-political issues that affect your parents directly.

Another unintended consequence -- this one related to America's social welfare programs -- is that the very rich and the very poor have either private or government benefits that will assure their elderly parents a reliable level and type of care.

The uncertainty and difficult decisions about elder care fall to caregivers helping middle-income elderly people -- those who make too much to qualify for state or federal programs, but not enough to write a check for the best assisted-living center or in-home care.

Elder care consultants urge advanced planning as the only way to avoid financial havoc brought on by an aging parent with expensive needs and no assets; but they also admit most older people are not well prepared. These older people usually assume -- wrongly -- that they can count on government programs to provide long-term care.

If you're like most Americans, part of the reason that your parents' cries for help come as such a shock is that you don't spend a lot of time around old people who need assistance.

The segregation of old people into planned retirement communities or institutional care facilities has left many Americans with no idea about what it means -- in a financial, emotional or physical context -- to be old.

You're going to need to know more about these matters. Caring for your older parents may be too expensive to contract out and is surely too complicated to delegate. Regardless of whether your parents live on their own, are in a supervised environment, stay in a critical-care facility...or even have a "grandma flat" that you build over the garage...you are going to make a lot of decisions you may not have expected.

Not every person is able or willing to have an older parent move in with them; but older family members living in three- or four-generation households are sure to become more common in the 2000s and 2010s. And even this doesn't resolve everything about elder care. You're still going to need to know the mechanics of how your parents' retirement money and medical coverage works.

This books covers all of that.

Longer lives mean more costs and new financial issues. The real estate industry has recognized that opportunity by inventing tools like reverse mortgages. The insurance industry has recognized it by creating flexible long-term care policies that allow benefits to be used for home care as well as nursing homes. However, insurance companies leave the details of these flexible plans up to you to discover.

This book covers all of that.

If you bought this book because you just had a scary conversation in which your father admitted he can't balance his checkbook anymore...and he needs you to take over, you've come to the right place. Calm down. You can honor your father by making sure he's going to be okay -- and as comfortable as circumstances allow. Tell him you'll do that.

Then use the tools and tactics we discuss here to straighten out his accounts, clean up his finances, get his insurance working right and do your best to keep his spirits up.

And keep the book. Someone else you know is going to need it.

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