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# 									Eldercare							

Global Community Liaison Office

		Contact GCLO Support Services		

## 								Caring for Aging Parents							

        -  Caring for elderly parents is a major concern of many Foreign Service employees and their families. How to ensure good health care, find the right living situation, and handle legal questions is often complicated for Foreign Service employees and their families while serving on overseas assignments. While it is difficult to discuss sensitive issues of aging, families who have agreed on plans will be better able to handle situations that may arise. It will be worth the time taken to research topics such as how to communicate with aging loved ones, medical insurance, eldercare housing options, finances, legal issues, etc. before there is an emergency. 

### Elder Care Resources

##### WorkLife4You

WorkLife4You (WL4Y) is the Department of State’s 24/7 comprehensive and confidential resource and referral service for employees and their family members. WL4Y will help employees and family members find programs, providers, information, resources and guides for life events, including caring for aging loved ones. Call them for 24/7 personalized assistance, read articles and educational guides on their website, order topic-related kits, engage in monthly live talk, watch webinars and listen to audios or ask for a free in-person elder care assessment from a qualified Professional Care Manager.

Department of State, both Civil Service and Foreign Service employees and family members are eligible to use WorkLife4You. For login information, contact GCLO at GCLOAskSupportServices@state.gov.

Visit GCLO’s List of Federal Agencies’ Employee Assistance Programs (EAP) webpage or contact GCLOAskSupportServices@state.gov for help with contacting your agency’s EAP.

##### Employee Consultation Services (ECS)

The Department of State Employee Consultation Services (ECS) provides confidential services to assist Foreign Service and Civil Service employees, who may be experiencing professional or personal life challenges. They offer services in person and virtually, both domestically and abroad.  ECS also conducts eldercare support groups for employees and their families who are responsible for an aging relative. The groups meet virtually to share issues, resources, and approaches to the problems that arise as an elderly person declines, including the issue of emotional stress that occurs for family members watching such decline. Email: MEDECS@state.gov.

**Employee Consultation Services (ECS) – Virtual Support Group Open to Members of All Foreign Affairs Agencies and Locally Employed Staff**
        - Eldercare Support Group   Meets the 1st Tuesday of each month   Time:  12:00pm – 1:00pm ET  Please reach out to ECS at the Department of State for additional details:   MEDECS@state.gov  +1-202-634-4874

* USAID employees and family members should contact USAID Staff Care.

##### Additional Resources

*The Global Community Liaison Office (GCLO) resources do not constitute an endorsement or recommendation of any particular organizations by GCLO or the Department of State.*

American Bar Association (ABA) Health Care Decision-Making Resources Health care advance directives (such as a living will or durable power of attorney for health care) are critical.  However, having a written advance directive by itself does not ensure that a person’s wishes will be understood and respected. Studies have shown that standard advance directive forms do little to influence end-of-life decisions without: 1) informed, thoughtful reflection about one’s wishes and values, and 2) personal communication between an individual and their likely decision-makers before a crisis occurs.  TheABA’s Tool Kit for Health Care Advance Planningdoes not create a formal advance directive for an individual. Instead, it helps individuals to discover, clarify, and communicate what is important to them in the face of serious illness.

American Foreign Service Association Retirement Services AFSA’s Retirement Services Division’s mission and work is to, “offer guidance to both active duty and retiree members on a full range of benefit and work issues germane to life post-Foreign Service and strive to support the Foreign Service’s experienced and gifted retirees in making the most of their lives post-FS including helping to spread the word to the American people concerning the critical work of the Foreign Service.”

AFSA also produces the bi-monthly AFSA Retirement Newsletter, which provides information on retirement benefits issues, activities, and programs geared towards those approaching retirement and in retirement.

Federal Long Term Care Insurance Program The Federal Long Term Care Insurance Program (FLTCIP) provides long-term care insurance for its enrollees, who are Federal and U.S. Postal Service employees and annuitants, active and retired members of the uniformed services, and their qualified relatives.

### Adding Parents to Orders

Foreign Service employees may request that their elderly relative(s) (including stepparents and legally adopted parents) be approved as an eligible family member and added to their Post Assignment Travel Orders for an overseas assignment. Employees of other agencies should contact their Human Resources representative with questions about agency-specific procedures and forms.

To add a parent to orders, the employee must complete an OF-126, the Foreign Service Residence and Dependency Report. Each new OF-126 replaces the old OF-126; therefore, all blocks must be filled out each time a new OF-126 is done. The new OF-126 must be forwarded to the employee’s GTM PCS Analyst. Travel orders cannot be authorized for newly-acquired eligible family members until the GTM PCS Analyst receives the OF-126 form.

Along with a completed OF-126 form, the employee must prove that the relative:
        - Resided with the employee for at least six of the last 12 months, with some exceptions noted in  14 FAM 511.3 .
        - Is at least 51 percent dependent for support (subject to review and approval per  14 FAM 510 ; USAID Officers must open a request in ServiceNow or reach out to the HCTM Contact Center at  HR-Helpdesk@usaid.gov  for assistance). The employee must quantify that they have provided more than 51 percent of support by submitting an affidavit or notarized statement testifying to that fact. This is termed passing the “financial support test.” For a template of a worksheet to show financial support and contributions, please email  GCLOAskSupportServices@state.gov .

The employee must also provide:
        - An explanation regarding the parent’s residency is also required, with an explanation as to why the application is being made to add the parent to the travel orders.
        - Other documentary evidence that may be required by the employee’s agency.

These documents are attached to the completed OF-126 form and sent to the employee’s agency as specified on the forms. Requests are reviewed for approval by a Personnel OF-126 Committee.

Please note that a parent’s gross income cannot exceed a threshold amount as determined by the Director General on an annual basis per 3 FAM 511.3. Please inquire with a PCS Analyst to find out what the threshold amount is at the time of application.

***Note that the parent may only be on orders as an EFM for one tour. The employee must reapply for each overseas posting.**

Employees of the Department of State can obtain advice on how to put their parents on orders through the Career Development and Assignments (CDA) division. Ask for an Assignments Support (CDA/AS) Officer. Employees of other agencies should contact their HR representative.

### Bringing Parents to Post Who are Not on Orders

Parents may also travel to post as Members of Household (MOH) but will receive minimal official support from the U.S. Government. MOH parents are responsible for acquiring their own visa for entry and residence in the host country. Upon request, the Human Resources Office at post may assist in the process in accordance with local laws.

Some countries require additional documentation by the accredited employee and all countries hold the authority to approve or deny any visa. Furthermore, they do not have diplomatic status with the host country and are not entitled to access the U.S. embassy or consulate health units. However, the Health Unit may provide them with a list of referrals for local medical professionals.

Finally, MOH parents are not eligible to receive airfare or allowance payments in the case of evacuation from post.

### Family Medical Leave Act and Family-Friendly Leave

When caring for an elderly relative, be sure to check the provisions of the 1993 Family Medical Leave Act on taking leave for this purpose and contact a Leave Specialist. Department of State employees can contact a Department Leave Specialist in the Office of Employee Relations (GTM/ER/WLD) about paid and unpaid leave.

Department of State employees may request a free copy of FIVE WISHES from the Office of Employee Relations, Work/Life Division (by email to ER/WLD on the global address list). FIVE WISHES is a planning tool and legal document in most U.S. states that combines the features of a living will and a health care power of attorney.

### Eldercare Emergency Visitation Travel (Eldercare EVT)

In January 2001, the Eldercare Emergency Visitation Travel (Eldercare EVT – 3 FAM 3742) provision was implemented, permitting travel at government expense for employees and eligible spouses serving at an overseas post who need to assist parents in declining health. Eldercare EVT allows the employee a total of two round-trips during the employee’s career, which can be used for one or two parents or individuals who have stood in place of a parent for the traveler during a significant portion of the individual’s childhood prior to age 18. Eligible spouses are also separately allocated two trips for eldercare of their own parents. In contrast to other forms of EVT, an employee may designate their spouse to travel in their place, or vice versa, as needed.  For questions on Eldercare EVT please contact EmergencyVisitationTravel@state.gov.

### Taking an Elderly Relative to Post

If elderly relatives are classified as eligible family members, they may travel on diplomatic passports and may have the same diplomatic immunity as a spouse or child; however, this is subject to the laws and policies of the host country of assignment. If not classified as such, elderly parents use tourist passports and do not have diplomatic status. In either situation, the host government of the country to which the employee is posted may have their own policies, rules, and conditions for granting the diplomatic visa or resident status to the parent. It is incumbent on the employee to advise post in advance and find out if there are any specific host country restrictions or additional conditions.

Housing assignments are based on the number of official eligible family members the employee brings to post. Travel to and from post (with the exception of medical travel) is also available to all elderly parents designated as eligible family members.

Elderly parents, regardless of their status, are not covered by the Foreign Service medical insurance program and do not have access to the health unit. Employees may, however, ask the Health Unit for names of local physicians who can provide medical services for their elderly parent(s). This kind of assistance from the Health Unit may also be requested during the bidding process, to determine if a post has adequate local health care providers to meet the medical needs of a parent(s).

Because elderly parents are not covered under the Foreign Service medical insurance program, they also do not have access to embassy medical evacuation (medevac) services. Therefore, all parents coming to post for either a short or an extended period of time should purchase and maintain Air Medical Evacuation Insurance. A list of companies that provide this insurance can be found on the Department of State Consular Affairs website.

### Medical Insurance

It is essential that a parent going overseas, either officially or unofficially, have adequate medical insurance. Medicare only pays medical expenses in the United States and in Canada and Mexico under limited circumstances.

The insurance companies listed below provide a variety of coverage and can be contacted for more information. Pay special attention to the “age limit” noted in the policy.

Allianz Global AssistanceAvailable to U.S. residents only. A policy may be purchased only while client is in the United States, but coverage may be available worldwide.

American Foreign Service Protective Association (AFSPA)Provides plans for family members and friends not eligible under an employee’s Federal Employees Health Benefits Program (FEHBP). The plans also provide coverage for U.S. citizens spending extensive time overseas.

Blue Cross/Blue ShieldProvides coverage to Americans living abroad only through the local offices where the clients have residence. Insurance may be purchased while the client is overseas.

Clements WorldwideClements Worldwide provides overseas major medical insurance, including full worldwide evacuation services. Coverage is offered for individuals as well as families. Clements also has policies for shorter-term travel.

International SOSProvides only supplemental coverage including a hospital deposit repay, medical referral, evacuation to facilities for treatment, legal assistance, and a toll-free hotline. Medical centers are located throughout the world.

### If an Elderly Relative was a Foreign Service Employee or Spouse****

****Senior Living Foundation 

The Senior Living Foundation of the American Foreign Service, sponsored by the American Foreign Service Protective Association (AFSPA), provides information and assistance to retired Foreign Service personnel and their surviving or divorced spouses and, on the basis of need, helps to defray the costs of home health care, senior housing facilities, long-term care insurance, or other services that contribute to their health and security. The Foundation is especially concerned with the 14 percent of the 11,000 retired members whose small pensions keep their income at or below the poverty line.

The Foundation’s Resource Center provides information about and assistance in obtaining community, State, and Federal resources. A licensed clinical social worker with Foreign Service experience reviews each case to determine the best resources available for the individual. Help ranges from volunteer visits to long-term care planning to advice on the legal maze of Medicaid.

### **Disclaimer**

Listings of private entities on this page are provided as a convenience and should not be construed as an endorsement by the U.S. Department State or the U.S. government of the entity, its views or the products or services it provides. The order in which names appear has no significance, and the links may be removed at any time at the discretion of the Department.

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