hi i'm tom callahan and welcome to all the seniors the show where we discuss senior living and elder care issues and options our topic tonight is part two of having the talk with your parents no it's not that talk it's the talk about their future it's an important talk on our last show and this show as well we have four experts in the field to discuss the different parts of the talk and how to frame the talk we're going to start over here on my left but and king was  so we discussed you know when is a good time to have the talk who should be involved and how to prepare for the talk on the show i want talk about framing the talk let's get started what points should be involved with the talk that we have caregiver has with their parents and that's kind of the talk about framing so you know i'm just thinking like you know how how much how much of a wide ranging conversation do you want to be well if it's not you you can have a wide ranging conversation well what are what are the what are the opportunities what are the threats to my parents well being how can i deal with those and that's a nice wide ranging general conversation that is not the conversation i'm having with my parent you know i'm going to go in and say here is something that bothers me or here's something i think we have an opportunity to do something great with or you know i really think we're doing great here at home i'd like to try you know i think you want to do this i think we should continue to do this how do we make this work build consensus and by your narrowly framing the issue in this goes back to what we had talked about earlier let's try and have this piecemeal over a period of time rather than saying well the following thirty three items on the interview will be covered in tonight's meeting and we will adjourn afterwards you know that sort of thing i think that if you have an opportunity to start to talk i would start with what's important to you what you want what do you want to do you know what's important to you to stay at home do you want to be social once was the most important and don't expect a good answer now expect a crappy answer the first time you ask that question because when you ask people what's important oftentimes it's very hard to vocalize them right but once you get something sees on it you can stay narrow and work on that one little thing and then see where it takes you know i think another important part of this is to understand what your parents finances are because without knowing what they can afford you really can't decide where they're vowing or what services to bring in so really knowing what they have whether their assets are worth what their income i find that many people will say oh available here about assisted living and not think oh my god it's so expensive and yet they'd like to move but they they hold back because they fear that they won't be able to afford it i hear this day in and day out so they think ok i'll stay home and i'll have home care and services brought in which is wonderful but sometimes you should dig a little deeper and be clear about what it is they have to they have a house that's an asset do they have a high income so they have good pension or do they are they eligible for pensions that they may not be aware of veterans benefits  other benefits for spousal benefits through the v a attendants and carl you talked about that earlier so there's a lot of there's a lot of things that people need cleared up and that can be part of the talk is what we have to work with now ok can we do home care for a few years should we look down the road at assisted living if mom or dad decides that it's getting a little isolated being at home alone so it's an evolution and there's not one answer  but it does bear knowing how much you have because if you're very limited in your income and assets then that's a whole other issue and you have to look at services that are more affordable and as mentioned earlier there's always medicaid program so it's mindful to know what you have and in the bank it's amazing the difference in terms of playing you can do if you have somebody who's got a decent income and wall and term care insurance i am not an insurance salesman nobody at this table but my god if you and this is not something you can tell your parents who are in their seventy's or eighty's the ship is kind of sailed by then but if you're in your fifty's boy think about long term care insurance because you know when somebody people come in and they're all you're a lawyer you do accept planning yes so you know we have this situation of two identical people with a house and some modest retirement assets same income one of them has a nice long term care insurance policy that they've been salting away and one of them doesn't the planning options are trast tickly different in your care options are drastically different because it turns out look at this you can you want to stay at home i hate this is doable you you think that you want to try an assisted living well it's not that assisted living or bust it's well we have basically any option we want you know we want to do some modifications in the home you know it's not just well i hope to grab or does it if we need ok we need to splash out for the chair you know the going up the steps you know we need to we need splash out for some of these more major modifications to a home we can do it because the long term care insurance will cover what the on ordinarily done yet i think just making sure that you as a loved one around that table ask the right questions and really like that open ended question what do you want or what do you want to be able to do what do you like to do where do you want to be in five years almost like your first job interview but having those questions out on the table just gets those wheels turning and so that then as you look at the facts of the finances or the situation of health or lack of health then you can entertain all sorts of conversations and knowing that one decision you make today may be different tomorrow and that's ok and that that that is a really great point because it doesn't this is the talk but it is not the decision right  down to it what are they having how healthy are they having health issues is it their eyes is it you know has it is it a stroke so what are their deficits and so you really do need to do the needs assessment your own personal needs assessment what are you observing when you go visit your mom is she leaving things in the refrigerator or things getting furry in there you know is how is her vision house or her health battle oftentimes sturrock the road map to what services need to get in place some people just need help driving my mother doesn't drive she can't see the macular degeneration so she doesn't need help with the personal needs but she does in some once take her food shopping to the doctor so that's one program that you provide through him hand in ships th home health agency and so that person might just love to stay home for the rest of their life and modify it with maybe a stair left or their shower and all that sort of thing but asking them what they need help with could be the start of the conversation because that'll be here in together ok so that's all you need help are if that's good you're not driving as much ok what if i found somebody that could help you what do you think about that let it set and then revisit that you know again your next visit so it's an evolution but that can be part of the i think it's a really good point that if you see food in the refrigerator that shouldn't be there the elderly often lose sense of smell and sense of taste so you can walk into their home and smell rotten armoring if it looks like bills are not being paid that's time to have a conversation if laundry is not being done if maybe they haven't showered as often as they should these are all good but these are all things that point you in the direction that it's time to talk if you haven't haven't already and interestingly enough those are not things that you're going to hear from your mother your father exactly you're not going to say well you know that we're that orange but i can't kitchen for example there's post it notes all over the kitchen counters and cabinet stating maybe what's in that cabinet but then fifteen reminders that are written about different events coming up are different things well we all  calendars we all use reminders but maybe there's been a change in mom's kitchen and how it looks or maybe there's also notes all over the bathroom or maybe there's other areas that she's not going to mention but you can observe and then ask that follow up question and really make it a collaborative effort so it's not i have all the answers and i'm going to fix this but what do you think about maybe having someone coming in once a week and checking on this mom  so we should be hitting things like the environment in other words you know the head of the house environment and how the parents are living and then every also mentioned the financial we should be hitting on the financial parts of what what we have and what we can afford and i would also like to interject that we should also be talking about the legal you know what you know i'm going to throw this over is do what paperwork should we have well talking about and this is coming from a guy who gets paid to draft wills who asked the most important documents that you can have not even close i mean because the fact the matter is long term care and you know hillary  the communities are great but there's there because the money is there you know home care is there because the money is there you know and so what ends up happening is people people spend down they have a lifetime worth of of savings and where does it you goes to high quality care and they you know they end up on public benefits and that not having the money in the world really doesn't matter well how do you arrange for that stuff in the meantime how do you make sure that the care is where it needs to be when it needs to be there power of attorney for financial matters ok and some sort of a health care document this is the legal portion the program might you know so in the first part of the program and had made reference to a five wishes document which is one of those series of documents that was created to address specific health care wishes for an individual and also appoint somebody to make those decisions and generally the rule is that  a health care proxy is allows you to appoint somebody to make a decision but only if you yourself can't make that decision because otherwise you know my and my wife would be taking me over to get flu shot and whatever else and we don't want to  you know even though clearly she is in charge it's just not so the idea though is that i say his health care document because there are lots of them we all know we've heard living well over advance medical directive post which i keep being reminded of the practitioner's order for life sustaining treatment because i learned originally as physicians order for life sustaining treatment and they said that in front of a nurse practitioner she punched me in the arm we must be careful but the point is there's a lot of these documents and i've hijacked things for a minute or two i apologize but there's a lot of these documents and that ends up being in place but you know depending on the assets depending you know that portion with conversation which is a really great conversation to have there may be other things that are involved if mom or dad is a veteran there are some benefits there and lawyers are not the only people that can get those benefits for somebody but it's one thousand dollars a month and that means a lot you know or more could be two thousand dollars a  know medicaid can cover in home services and community based services it can be a huge deal also really difficult to apply for you know it's not possible people do it on their own but it's difficult but you know you get those things in order you get the documents in order all the sudden that part of it becomes less mysterious and that is what we are trying to abolish with the talk i think ultimately i would i would submit that the purpose of the talk is to abolish mystery and make things and bring things out into the open where we can gaze upon them and realize what we've got going on at least i had something to thank you for bringing up medicaid out of people to understand that medicaid is actually part of  at least ten percent of their population what does that mean that means somebody who's in an assisted living facility paying privately can actually apply for medicaid and stay most of the time in that facility in a studio apartment so they only have to demonstrate that they have financial assets for a couple of years not for the rest of their lives just for two or three years and it's facilities different so there's a safety net there and that's medicaid it's the called the medicaid waiver and assisted living chronos about that so it's a way for caregivers to be educated when they're speaking to their parents not to assume that it's so out of their parents financial reach it can be very affordable but again you have to do your homework topic and if you want our on it i'll give you our if you don't have an outlook so it's not about that you know it's not something else yet but i see what we have here is we have how the financial is actually somewhat married imparts to the legal so again these are two major points to be bringing in here as well as the environment in the house you know i want to get into what if it's not well received because this is where we really get into a you know us mom what do you want i want to say here i don't want to talk about this but you like kitty brakes are on you know it's always good to have a plan a and a plan b everybody wants to stay home they want to age in place ok so if we're going to age in place what do we need to know ali well there's so many basics logistically about staying at home and if you know that for example you may already have a degenerative condition like parkinson's disease for example or cement that is perhaps rapidly progressing just the a first floor bathroom a safe environment with minimizing or eliminating all the steps involved having a first floor bedroom and living arrangement completely and then having access to some of the  resources that might be able to be brought in through home carries and so your other services have someone to bring the groceries take out the drugs do those things you know those are the logistics of it and that that's you know a piece of the whole puzzle of trying to figure out can i stay home and you know as i sit down the professional point out if the home could be modified if it's not already conducive we need to make modifications and if we do make the modifications or staying home we're going to bring in home care  what should they go what should they be know about home care what is it that what is it that they that that person is going to be cared for what they feel comfortable with do they feel comfortable having someone just do the laundry and make the bad  prepare a meal do errands will they feel comfortable having someone a caregiver shower them you know if that's something that's completely off you know off the table for them that might be a need to look into a different option but home care can start anywhere from just a few hours of driving all the way to preparing meals and then to twenty four hour twenty four seven eleven but it's what does the person in the home feel most comfortable with  o i this is addressed actually both of you have a question all too often you get people who will try and address this in a very left brained manner very clinical matter talking about so called activities of daily living elves which is something that's like a very clinical thing that people talk about and there's a list of x number of these eighty l's that they're used to measure eligibility for all kinds of programs is that a helpful way to benchmark it for  caregiver to talk about it in terms of what we need to target the following or is it more of a is there a more holistic way to approach it that it's more effective with a caregiver and i mean certainly i wouldn't bring it up that way with a parent but with a caregiver when they're when they know how to target a conversation for i care if you're for me as a professional caregiver i'm not talking about the son or the daughter or the granddaughter right so for me that that is the appropriate way to talk about that specifically professionally what do they need and not only that but also motion lee and spiritually you know when they need and that's something that that we look at but i think assessing the activities of daily living is all part of what an occupational therapist does for example so really having a framework in place of you know what do you really need help with this this activities of daily living of showering or is it just that  mom you need better lighting in the bathroom and then you're going to be able to actually do it yourself and we don't have to go to x y and z and get twenty four hour care in there just because a light bulb needed changing i was looking at it  so we're going to wrap up i want to seconds each from you what your companies to start with and we are home health care agency specializing in in home senior care and even under that we specialize in home is to advocate for caregivers and provide services ranging from asset protection in document perp aeration to application for government benefits and associated litigation services if they're necessary to protect an elderly