Caring For An Aging Loved One

Conversations with the Aging Parent Answer Team

If you are caring for an aging loved one, or aware that it might become one of your roles in the future, you might be interested in this article. On October 27, 2022, I moderated a Q&A panel discussion with the Aging Parent Answer Team or APAT. Who is APAT? They are professionals with expertise around various aspects of caring for aging loved ones: Long Term Care and other types of insurance, Senior Real Estate, Estate Planning and Elder Law, Home Health and Hospice, Downsizing. The event was sponsored by BlackRock and held at Pinstripes in Overland Park, KS, and hosted by Aspyre Wealth Partners. Following is a transcription of the questions asked and answered during the event on October 27, which sold out, so another event was held on November 9, 2022, to continue the conversation. Both transcripts are included below.

It's a long transcript, but I wanted to honor the requests I received by people who were unable to attend in person. Keeping my word, you will find the whole conversation. There's a ton of great information here.

Big shout out to Dawn Crouch, LUTCF?, CLTC? - Friendly Local Agent , Kirsten Schroeder Larsen , Brandie Gholson , Terri Monrad , and Peggy Shults for sharing their time and expertise with us.

Let's dig in.?

Angela Kreps? 0:04??- Hi, I'm Angela Kreps and I’ve been an Aspyre client since 2008. I joined as Chief Connector in 2019, connecting people with Aspyre to help open their eyes to a different style of wealth management and financial planning. Some of the things that we work on specifically at Aspyre is accompanying you on your unique journey as a wealth partner - through all the stuff that gets in the way of life just being a straight line from here to where you're heading, right? For example I've gone through my own challenges working full time and managing the struggles with an aging parent. Currently I’m the primary caregiver and power of attorney for my mom. When I met the aging parent answer team, they answered a lot of my questions. I found it immensely helpful. So when we talked about it at Aspyre we said,? “we should offer this to our clients and friends and see if they can get some of their questions answered.” So the way it goes is there are questions from the file box that they've given me. I'll read one of the questions to get us started after we do introductions. Then as you have questions, please ask them. First, each member of the Aging Parent Answer Team will introduce themselves. They all cover a specific service area in support of our aging loved ones. I want you to hear it from them because they're the ones who know specifically what they do best. We'll get a lot of questions answered tonight. We were sold out today. So we did create a follow up event with the same amazing aging parent answer team on Wednesday, November 9, in about two weeks. So we'll start it off with Brandie and then we'll just go down the row.

Brandie Gholson? 1:49??- All right, thank you so much. My name is Brandie Gholson. I am with Absolute Genomics, a lab company. We do testing for respiratory. We do testing for STDs. We do testing for COVID. Any type of lab tests you could think of, we do. I've worked in the healthcare business for over 20 years and have experience in home health, and also the nursing home business as well. So any questions that you have about Medicare, Medicaid, I'm your girl and anything healthcare, I'm gonna be able to handle that for you. So if I don't know, I'll definitely find out for you.

Dawn Crouch? 2:23??- Hi, I'm Dawn Crouch. I'm the owner of Safe Oasis Insurance and I answer all your insurance related questions. The really exciting ones.

Terri Monrad? 2:30??- I’m Terri Monrad and I'm with Coldwell Banker distinctive properties. I've been working with older adults making moves for about 20 years and on and off, but I'm now on the real estate end and just making that an easy transition for them.?

Kirsten Schroeder Larsen? 2:52??- I’m Kirsten Larsen the owner of Schroeder Larsen Law, a life and estate planning law firm. I focus my whole practice on drafting and producing those estate planning documents such as power of attorneys, wills and trusts to make sure that you're protected during your life or your parents are protected during their life and you can help them when they need it. And then the transition afterwards goes as smoothly as possible.

Peggy Shults? 3:22??- And I am Peggy Shults, co owner of Resettle Me. We are Senior Move Managers in the Kansas City area. We help older adults and their families with the actual process of moving. A lot of times that involves help figuring out what to do with all the extra stuff! I am happy to answer questions about anything that's moving related.?

Angela Kreps? 3:49??- Welcome to our Aging Parent Answer Team. And the first question I pulled is for Peggy:

How should we select an estate sale company? #estatesale

Peggy Shults? 4:05??- When people can use an estate sale company, it is hands down the easiest way to get rid of things that they’re not taking for a move. Unfortunately, what we see in our line of work is that by the time people are taking things to their new residence and the kids also come and take some of the nicer things, there's often not enough left to have an estate sale. So in terms of selecting an estate sale company, the thing to talk about with them is their minimum value of the available property they require in order to do a sale. There are a few tiers in our Kansas City area. Some companies will take sales down to about $7,000, and others require a minimum of $40,000. So first, do you have enough potential value to offer? Then, when choosing an estate sale company, good things to do: go to some estate sales, particularly in neighborhoods that have homes of about the same price range as yours. See what their sales are like. Do they seem to be well run? Are they well organized? Do the prices seem good? And finally, if you can, talk with people who have used them.

Angela Kreps? 5:17??- Great advice. Next one I pulled is for Dawn:?

At what age should I consider buying long term care insurance? And when is it too late??#longtermcareinsurance #longtermcare

?

Dawn Crouch? 5:30??- Fantastic. My favorite question of all. I like to start talking to people about long term care insurance when they turn 40-45. Now, that's early, but there's a reason for that. I want it to be like an exit five miles ahead sign. So they begin thinking. Then when the right moment appears, they don't delay. There are some companies that will allow me to write long term care policies all the way up to age 80. I've never successfully submitted an application for someone beyond about 73-74. Simply because Long Term Care Insurance is the most difficult to qualify for. You have to be very healthy. So by the time someone's 73-74, they've got some health challenges that are most likely going to prevent them from getting a policy -- even if they're willing to pay a lot of money for it. So that tighter window of when people should seriously dial in is about 50 to 65. My suggestion is to start earlier rather than later.?

Angela Kreps? 6:34??- We've had a couple more people arrive. There are chairs over here. While they are getting settled, I’m going to introduce my colleagues who came with me to this event. Blackrock has generously underwritten our event, so thank you, James, for your sponsorship. Standing next to James is Jessi Chadd. She's a principal at Aspyre. She is a certified financial planning professional, as are all of my colleagues who are here tonight. Aspyre is a fee only fiduciary firm and as part of that designation, the certified financial planning professional, or CFP, is essential. Jessi also has a designation of certified financial transitionist, and she helps people specifically going through transitions. Next is Lucas Bucl, and he is actually my mom's financial planner. He's also a principal in the firm and he is our Chief Investment Officer at Aspyre. Next is my colleague Jamie Bosse, also a certified financial planning professional. Jamie is the author of three amazing books, two for kids and one for adults called Money Boss Mom to provide parents the financial advice and how to instill financial wisdom in kids starting at an early age. We will have time to mingle with them later. So is there a burning question from the audience??

Audience member? 8:45??- Yes, a follow up to the long term care.?

I know there are certain trigger events before those policies kick in. What are they and when does it actually activate?

Dawn Crouch? 8:59??- When policies were sold originally, it was the Wild Wild West. Every company set their own benefit triggers. So if you've got an aging parent right now that bought a policy 25-30-40 years ago, read the policy language because that's the only way to know for sure what will trigger that benefit. In the last 12 or so years that has become very standardized. So for policies being sold today, what triggers a benefit is one of two things happening. The first one is you have some sort of memory or cognition, Alzheimer's, dementia, and you need to be prompted or assisted throughout your daily routine. That alone will trigger a benefit. Or if you're of sound mind, but you're having physical issues, there's what's called activities of daily living, ADL. There are six of them. You need to need help with TWO of them before the policy begins to pay. And the six activities of daily living are really easy to remember if you think of your morning routine: 1. Can you get out of bed unassisted? We call that transferring. 2. Can you take a shower by yourself? 3. Can you dress yourself? 4. Use the toilet by yourself? 5. Do you have problems with continence throughout the day? And 6. Can you eat/make breakfast (meals)? Those are the six. As soon as your doctor writes us a letter that says, “Dawn needs help with these two” or “Dawn needs help getting through her routine because she's got a memory issue going on,” that will trigger the LTC policy.?

Angela Kreps? 10:26??Anybody else have a question?

Audience member? 10:32??

If your mother has her home and everything in her trust and she made me the Co-Trustee. Does she also need a will or is that all in the trust? #trust

Kirsten Schroeder Larsen? 10:48??- So usually, if you have a trust, you will also have a will and the trust is the beneficiary of that will. They will serve as kind of a last stop protective measure. It's to gather up anything that is what we would call “a probate asset.” It says some asset that doesn't have a beneficiary otherwise designated and it pours it into the trust for you. So yes, you probably need both documents.

Angela Kreps? 11:22??Any other questions? Ok. I’ll pull one. This one is for Terri:

How common are homes with in-law suites? Could it be a value-add to build one into my home?

Terri Monrad? 11:43??- I'm going to tell you that it depends. They're becoming more common in homes built today. You'll see them off the main living area, and can be used as a home office, in-law or caregiver quarters with its own ensuite bath. Yes, they can be a value add. I know of several clients that have made that in-law suite on their main level. You have to have a bedroom and a bath. But it would depend on your neighborhood. You never want to over build your neighborhood. So you would want somebody to run the comps on your neighborhood and understand what the value threshold is for that neighborhood. But they are becoming more common -- as are main level primary suites. We are needing more of those since so many of us are aging today.

Angela Kreps 12:33 Yes. A question.?

Audience member? 12:34??

I have a question about my mom, who is 84. She does not have life insurance. Is it worthwhile for her to get anything now??

Dawn Crouch? 12:45??- I know it depends on if you know Alex Trebec. (laughing) So I like to tell people,? “If you're gonna talk to a Canadian about your life insurance, it should be me, not Alex. He's officially retired.” Maximum issue age for final expense policies is usually about 85. And there are two varieties that are available. The first one, if she's healthy, it is what we call “a level death benefit.” Which means that if she passes away the first day she has the policy we pay the entire amount that was promised, $20-25,000 etc. For those that have some health challenges, we can do what's called a graded policy, which means that if you pass away during the first two years, we turn around and give you back your premiums paid plus interest but don't actually pay you the full death benefit. That becomes available the start of year three. So that's how we can approve people that have some health challenges. The question to ask is Have you already prepaid your funeral? If not, how much do you want to provide? Is it easier to start socking away some money towards insurance and then it's just dealt with from day one? Or do you want to kind of roll the dice and just hope there'll be money later on from some other source? from children from sold assets, etc. So if there's a need, there's usually a way.

Angela Kreps? 14:22??I've pulled a question for Brandie:

?What services can I receive at home through home health. And what does that cost?

Brandie Gholson? 14:32??- The home health benefit is the only benefit that is paid out by Medicare at 100%. So there should be no cost. So when a person has Medicare, they are able to get home health at 100% no cost to them, because the Medicare benefit pays for it. This is after whatever episode happens to say they fall they break a hip say they have some issues cognitively and they're not doing well with balance or transferring or like she was talking about they're activities of daily living (ADL) tasks. So what would happen is they would either get physical, occupational, or speech therapy, or nursing in the home. That's what Home Health provides. And so that benefit is actually paid out at 100% by Medicare. So nothing out of pocket. And if somebody tells you you must pay out of pocket, then run. That's not the right company to be with.?

Peggy Shults - But there is a limit to how long they'll do that.?

Brandie Gholson 15:22 - She’s right. There is. So how that limit works is if that person is continuing to progress, they will pay that out. There's no limit. There's only if they began to plateau is when they take them off of whatever service that they're getting. But they can recertify a person. If they have, they say hey, it's gonna take five visits, physical therapy, to get you back and running where you were. They do the five and it shows that she's still progressing. However, she's not back to where was before the episode, they will continue to recertify. Medicare will give us the goal of higher than the green light and will continue to give services.?

Audience Member 15:51 - I guess my question is does it has to have an event?

Brandie Gholson 15:59 - So when it comes to an event: a physician must give the order. Say mom is at home, and she slips and falls. It's not necessarily that an ambulance is coming to her and she's going to the hospital; however, she may have to go to the doctor's office. Physician says hey, looks like you would benefit from your home health benefit. Let me go ahead and get that. It's always a doctor's order. And that could be done with a phone call and a tele visit, meaning they can just do an actual phone call, FaceTime, and do telemedicine.

Angela Kreps? 16:51??It seemed like there was another question.?

Audience member? 16:53??

Well, I was gonna ask, is it a referral like your position? It’s a referral basis?

Brandie Gholson? 16:58? You're correct.?

Audience Member? 17:00

There can be several situations that all need to be addressed. And then you have multiple physicians providing? Maybe??

Brandie Gholson - When it comes down to that, it would just depend on the specifics. It depends on the toleration of the person because you really don't want somebody in there doing OT, PT and speech all at one time because they may not be able to tolerate it. So we do what's called staggering when it comes to that. When you're dealing with more than one physician. It depends on specifically what's going on in that specific episode. So you can't tell your optometrist to give you a physician's order for something that's going on with your foot. It's just not gonna happen. They would refer you to your podiatrist, and they would do it. So that's the only caveat to that. If you have several different physicians that you're working with. But it's all the same in that It's always going to be physician ordered. It's always going to be the Medicare benefit is paid for at 100%.?

Audience member? 18:01??

Okay, so my mother is in independent living but came to pass that she kept throwing away her medicine. So I hire people to come to provide assistance. They come morning and night to make sure that she’s taking her medicine. She's very compliant with them, but she wouldn't do that with me. That can't be covered, I guess? #homehealth

Brandie Gholson? 18:28??- Not through Medicare. So how that happens when it comes to nurse setups. It's not that she can't get that benefit if there's nothing going on with her. So if there's not an episode that actually challenges her for why she's throwing the medications away, then we can't just say that it's a nursing visit needed. But if there is a nursing visit needed because there's something going on cognitively – and you see there's a CHANGE in our cognitive facilities. It's a cognitive issue.?

Audience member 19:08

So it's similar to long term care insurance? A cognitive deficiency issue or some sort of problem in everyday life?

Brandie Gholson - Yes. If it’s an ADL, they’ll pick up and get the coverage in place

Angela Kreps? 19:21??- One more over here and then over there.

Audience member? 19:23??

Is there any help for emotional support for when you have a couple? They're both aging and they both have issues in trying to deal with each other's issues. I find with my parents, they're really struggling mentally and emotionally with the end of life for each other. They've been married for 64 years - in that phase of life, where they have no hope left.? I just see my mom, dealing with my dad - who has all sorts of issues, and she has her own issues, too. Trying to care for each other, but emotionally, they're really failing. They've had a wonderful marriage their entire life and now it's like they're crumbling, dealing with these issues.?#emotionalwellbeing

Brandie Gholson? 20:23??- I'm also a psych major by training. So when I say all things healthcare, that’s what I mean. When it comes to this I have two comments. One: you want to make sure that since social work is a part of the Medicare benefit for you as well, you can get a home health person to come in and do social work for you. They can come in to help and they can offer good places for the counseling that they would need. That is something that if they have that Medicare benefits, you can talk with your physician about it. Let them know that “hey, listen, is there any way we can go ahead and get home health and come in for the social work piece?” Then the social workers come in and recommend counseling. Two: The counseling portion is going to be private pay. So just want to make sure that we distinguish that Medicare does not pay for counseling services.

Dawn Crouch? 21:22??- I'm gonna ask you a question and break all the rules. When we talk about what benefits are available, what if they choose to go on hospice at any point??#hospice #hospicecare

Brandie Gholson? 21:31??- That changes the dynamic. If and when they are in need of hospice, and one of the things that I'm so glad she asked that question because one of the things I want you all to know is, it's never really too early to have conversations about hospice. Why I say that is because nine times out of 10 families come to us at too late of a stage when it comes to hospice. They think “oh, I've only got to talk about this when mom's about to die.” That is not the truth. It's really more beneficial for you to have what we called at my previous company “goals of care meeting,” where you talk about with them what their goals are right now, what their goals are. When they're ready to transition, what their goals are. While they are of sound mind, it's perfect to talk about it. I know it feels morbid. I know it feels hard. I know it feels like you don't want to have this conversation. Some people think “if we bring hospice then two days later, they're dead.” That's not the truth. And so that's one of the myths we want to make sure we dispel when it comes to hospice. It is a very important service because once they actually have that benefit, Hospice is not only able to come in and give them benefits. If you say, “Hey, she's declining. Her bed is not working for her. It's too low to the ground.” They can get you a hospice. Those things are all additive services, BUT they can also get the counseling services in for you and your family. They have several different types of service and types of therapy. So it just depends on which hospice company you use. They have all types of therapy that can help. What's happened is that people don't know this because they're just NOT TOLD or (they don’t) understand the benefit of hospice. But what can happen is that they can actually graduate off of hospice. Because of the attention they're getting. Because they are getting help to manage the pain. And once you start managing the pain, it seems like mom can move again. It seems like she can get around again. She wasn't able to do that before. It seems like dad's now getting up talking. He's now you know, he was listening to music and for therapy, but now it's actually helping to heal. He's actually able to move a little bit more than he was. And so sometimes that concentrated therapy is actually kind of what they need to get up from where they are, as opposed to hospice is going to kill them. Because that's what most people think, you know, and because they haven't had the benefit of knowing or didn’t understand it.

Terri Monrad? 23:54??- I was just going to say kind of a personal anecdote regarding hospice care. Many of us have parents who are very worried about the cost of everything. Rightfully so, because the cost of care is just crazy expensive. But hospice covers so much. It takes a huge weight off your shoulders not wondering whether some therapy to make them more comfortable or whatever is going to be worth it for the expense. Because it's all covered by their Medicare. So I would just second what Brandie said that the earlier you have that conversation regarding hospice, the better.

Audience member? 24:40??

I have a Medicaid question. My mother has, while it's not diagnosed, I believe it's dementia or Alzheimer's. She refuses to go to the doctor because she doesn't know. She's making me insane. I moved in after my father died because she just called me all the time. She doesn't have any long term insurance. She did at one time. She called it old lady land insurance. She has no idea who should paid it to. She has no idea if it was a paid up policy. I have no idea. A lot of my friends are telling me there's Medicaid to be able to be able to pay for her. If it comes to where she doesn't know anything or whatever. I'm going to keep her as long as I can. But they’re saying that there's a five-year look back. That it takes forever to get on Medicaid.? “You shouldn't be doing that now.” I'm getting all this unsolicited information and I don't know what's true. I don't really know what to do. I mean she has Medicare and all this is very good information because I'm really kind of afraid to have conversations about services. So first of all I've talked with the lady that is with Medicare but I didn't know all these other services are available. So I will be actually talking to her again because she called me to say to change her policy. Fantastic. She's on top of it. But I don’t know all this, and all the unsolicited information is overwhelming. It's very overwhelming. Everybody’s saying, “don't let it go to probate.” Like you don't want that and I'm like okay. I don’t even know what that means. #medicare

Brandie Gholson? 26:57??- That seems like a two part question. I'm gonna allow Kirsten to start, then I want to answer the question about “okay, so should I be applying to Medicaid right now or should not?’

Kirsten Schroeder Larsen? 27:13??- First I'll address the probate question. Most people want to avoid probate, which is the process of going through court to have a will or estate administered. And the only reason you want to avoid it is there's expenses and uncertainty and it can draw out the administration process unnecessarily. Sometimes, it's a necessary evil, if you will. It could take a lot of things off your shoulders, if you've got fighting heirs, that sort of thing. It could be easier to have an impartial judge saying you're getting this you're getting that end of story. Rather than them looking at you thinking you're the one making the decision. So that's one question. As far as Medicaid goes, there IS a five-year look back. Each state administers their own Medicaid program. And since it is need-based, you have to be really poor to qualify. So if there's no long term care insurance or insufficient assets to contemplate a private pay plan, you probably need to talk to an elder law attorney to start looking at that Medicaid application process. You will want to figure out if there's anything you can do to preserve certain assets for getting past that look back period. Say she gave you a gift of $20,000, then you need to get five years down the road before you apply for Medicaid or else that $20,000 is going to be considered part of her assets.

Audience member? 29:00??

Okay. See, like all of her financial accounts, she put me on them. Like banking accounts and everything, she put my name on them to receive payment in the case of her death, not an owner. Does it start at that point? Would that be looked at?

Kirsten Schroeder Larsen? 29:30??- So without giving you actual legal advice, there is a difference between being a Pay on Death beneficiary and being a joint owner of an account. And so that would be one of the things that an elder law attorney could look at for you.

Angela Kreps? 29:49??- I don't know if this is exactly related to that. But my mom did the same thing. She added me to all of her accounts, so that I could take care of stuff if she couldn't. We had to make sure there was a power of attorney that was not a springing power of attorney, but a standing durable power of attorney.

Kirsten Schroeder Larsen? 30:12??- Yes. You've got a power of attorney??

Audience Member - Yes.

Kristen Schroeder Larsen - Okay. So that lets you sign checks on her behalf without being an owner. You want that distinction. That tends to be the default. I've run into that a lot.

Audience member? 30:52?

And the house is in the trust. She put me on the deed, so that will come to me, right?

Kirsten Schroeder Larsen? 30:58??- No, if the house is on the trust, then the trust will determine who it goes to. If she goes on Medicaid, they're probably going to be able to put a lien on that house. Now you can protect a house if there's a surviving spouse but I think you said your your father had passed so that doesn’t apply in this situation. So even though it's in a trust, more than likely it will be considered as one of her available assets when calculating Medicaid.

Audience member? 31:33??

So if I put her into a home, basically, whatever it is, that must surpass the five years, look back from there? Medicaid - that's what I don't understand. Because everybody says it's a five year look back, but I have no idea where it starts. Like she's actually approved as Medicaid and that starts the clock, where it's when she first takes any benefits from Medicaid. Or does it start when she applies?

Kirsten Schroeder Larsen? 32:16??- Let's say you have a $500,000 home. Medicaid is a pretty difficult thing to qualify for. You have to be really poor to qualify for Medicaid. So if she leaves her home and you sell the home, those would be considered her assets, so she might not qualify.

Audience member? 32:40?

So how do you afford a care facility? Because it's $8,000 a month.

Kirsten Schroeder Larsen? 32:48??- We just went through this within our family, it is crazy how expensive it is and hard to get into good places.

Audience member? 33:00??

I've actually moved in to take care of her. And so now basically doing that, I don't get an inheritance. I might still get the house but you see what I'm saying??

Brandie Gholson? 33:14??- Right. That's why you want to make sure you talk with an elder law attorney. They can walk you through the steps of what's going to be needed. What can protect her assets? and what can be spent down? Medicare will want to see what is spent down to make sure that okay, everything is gone. Then they say we can help. And that's what that means. We have some great elder law attorneys that we can share at the conclusion.?

Audience member? 33:42??- Yes, because, I mean, it's just so confusing to me.

Brandie Gholson? 33:45??Yes. It can be. That's where your elder law attorney comes in. Because they know how to specifically get into where you've spent down and everything. They've placed the assets where they need to.

Audience member? 34:16??- It's kind of tough. We don’t want her to be in a situation where there’s nothing. We want it where she's got enough leftover.

Brandie Gholson 34:30 - Yeah. It’s hard to say.

Audience member? 34:33??She does still get social security. Okay. All right.

Angela Kreps? 34:39??- The self care aspect of this is important. It is hard to be caring for our aging loved ones. It takes a lot of energy away from ourselves. Are there follow up questions here?

Audience member? 35:00??

I have a question on that we're dealing with. Our mother who was having health issues and our father, who's a retired physician thinks everybody's trying to do everything for her and he's having burnout and depression. We're trying to figure out ways to help him get some rest. He needs to have something. Are there any services for the caretakers? #caregiversupport

Brandie Gholson 35:36?- There are a lot of services for caretakers. There's definitely respite care. That's one of the best benefits. But I wouldn't be surprised if you would have someone else talk to your father about getting that rest, because a lot of times what happens is when adult children are talking to their parents, parents are like “you're still my child. You're not gonna tell me what to do.” But when they hear a professional, it just the same as the lady was talking about her mom didn't want to take the pills from her. But if she were taking from someone else… They may take the information better from a professional saying, hey, you know, if you would do this, then you'll be able to even help take care of her. Because you have to get to self care and therefore, if you literally have someone else to tell them that may help you, for him to actually reach that point of getting the rest he needs.

Audience member? 36:29??

How do you get them to take that call though?

Brandie Gholson? 36:35??- There's a way to do it. A good way to do it, actually. Have dinner. Ask them to join you for dinner and say you are going to invite someone to join you. Have them come sit down, and he will talk with you. Talk with him and begin to have the conversation. Now you don't have to go lie to him. Say, “hey, Dad, you know, we're gonna have a dinner and we are inviting somebody who I think would answer a lot of the questions that you may have, but also help US to help YOU.” And so that might work. I mean, it goes a long way. One - because it gives them more options as opposed to telling them. Two - it's coming from somebody outside of their kid because they are saying, “I feel like I'm still supposed to take care of you. You're still my kid.” Instead of: “you’re my adult child. You really love me. You want me to live a longer life, but this is my wife and I've taken care of her for this long. So how are you going to tell me.” That dinner, a meal can help solve it. It actually breaks down their walls.

Audience member? 37:54??

We have a problem with driving. We can’t take away the keys, they won’t give them up. Maybe they would listen if we just went to the neurologist. I don’t know??

Angela Kreps? 38:13??- The neurologist was that moment for us. The neurologist told my mom that it just wasn't safe for her to be driving. And then she was willing to turn over the keys. You kind of have to take them to the appointment and be in the office. They pull you in after they meet with your parent to recap the meeting because they know there needs to be a transfer of power when the neurologist says, hand over your keys.?

Dawn Crouch? 38:34??- Yeah. I think opening up a great conversation with your parents is by asking them about what went right in their opinion and what went wrong when they lost their own parents. Asking them if they have any, what I call “Never Evers”. Is there anything you never ever want to see happen? And then it starts to open up this dialog of, "let's make a plan so that never happens." And you can start asking what resources have you devoted to this? That's an easy way to ask, did they have money pigeonholed for that somewhere inside account you don't know about? They have an insurance policy they just never told you they bought. But if you start kind of coming alongside that and saying what is it you never ever want to see happen? Mom/Dad I want to be an advocate to help you get there. And if they ever lose their ability to communicate and you have to make those decisions on their behalf there's a ton of guilt that comes with that because you just don't know if the choices you're making are the ones that they would have made. And you can tell them I don't want to be in that position. I don't want to live the rest of my life regretting the choices I had to make for you in a moment of crisis because we didn't have any clarity.?

Angela Kreps? 39:53??- Because then they're back in the role of taking care of you.

Audience member? 40:05??

Can we go back to the hospice? What triggers a hospice benefit?

Brandie Gholson? 40:19??- That’s a great question. Triggering a hospice benefit can be if that person has a medical need for a service, and what is a disease process that will ultimately lead to end of life. However, that's what's going to trigger is an episode or incident or diagnosis. There are several different diagnoses, as we know, that can trigger. It could be something as simple as dementia. There are some people that a diagnosis can get them there because of their comorbidities, they have other things going on at the same time.

Audience member? 41:03??

Just to tag on to that, how does it start? Does it start with the doctor saying I think you might need hospice. Is that correct?

Brandie Gholson? 41:11??- So it is going to start with a physician, so no matter what it is. You're taking mom to the doctor, you have a physician that speaks to you about “hey, you know, your loved one has been diagnosed with big C word cancer.” That's something that can start the process of having a hospice representative because our breast cancer can advance. That can be something that can trigger it. So you were at the physician’s office, and they mention hospice. There are systems to choose from many hospice companies. And because they all have relationships with who they recommend, and you choose from those hospice companies. Have them come in and talk with you. Have your conversations. Find out what all that they have when it comes to their services.

Audience member? 42:01??Great.?

Angela Kreps? 42:04??- So this just happened in our situation. My mom has given me permission. She's a teacher. She's given me permission to tell everybody her story, if it's gonna help somebody else. It's going to make your way easier. So what just happened to us is I got called into a care meeting. She's in a long term care, memory assisted living facility. And during our care meeting, they said we've got two choices. She's lost 20 pounds over the last four months. And she's been to the ER three times in the last three months from falls. This has triggered either a need to choose rehab, or to choose hospice. And I was shocked because I had the false impression about what hospice is and thinking, she's not going to die in six months. I mean, what are you talking about? And they said, well, it's not that necessarily she’s going to die. I mean, it could be if she continues to lose weight at that pace. She had a subarachnoid hemorrhage last time she fell, so? if that happens again, who knows. But with hospice they get a higher level of care and then they can even graduate. When you think about it, it's so compassionate because there they get so many more services like music therapy and prayer companion. All of these other things, services that I didn't even know were available.

Audience member? 43:25??

With Hospice, do they have to move somewhere??

Kirsten Schroeder Larsen? 43:38??It can be either. It really just depends on where they are at the time they get that hospice benefit.

Brandie Gholson? 43:48??Right, there are certain places but the majority of this is actually coming to us. So they come to homes, they go to assisted living, they go to nursing homes.?

Audience member? 44:00??

So when you say you get a choice, we have not done anything beyond rehab in hospitals, sort of.? We saw her make progress and then she declines again and when I ask about it, it's just making apologies. I was thinking, this could be better, you know, because you're saying that they can get better. Can they actually get better?

Brandie Gholson? 44:17??- Yes. Because of the comfort. But also because of the services, like she said the added ancillary services where you're getting a prayer partner, you're getting the nursing, you're getting the additional equipment. Literally, sometimes get triggered for hospice is actually that's how they start to get better.

Kirsten Schroeder Larsen? 44:46??- I would say that sometimes just changing the meds that they're on can eliminate certain side effects and they seem better. Now we're just focused on making them comfortable. Whatever it was that was driving that hospice diagnosis sometimes goes away. So in our recent experience, the meds she was on suppressing her appetite. She wasn't eating. Once those were weaned out of her system said she was hungry again.

Angela Kreps? 45:15??- Amazing. So much hope. I pulled the green card. I think this is real estate for Terri.?

How do I determine what type of situation is best? For me or my loved one?

Terri Monrad? 45:37??- Wow. Such a little question. So I also have a background of continuing care retirement communities. So it's basically: Are your parents thriving at home?? Are mom or dad driving? And if they're not still driving, or maybe they shouldn't be driving? If they can't get out and can't be with their social group, they would benefit from being either in a community where there's an active homeowners association. Depending on their age, you know, when they're healthy. There are communities. There's 55+ communities which have age restrictions, so at least one of the residents have to be that age to live there. They have active homeowners associations where there are clubs and groups and they can have social interaction. Also, they get to eat with someone when they're living in a communal situation such as Independent living or assisted living. It's that most people don't want to leave their own home. So it's how you have that conversation with them like Dawn was talking about. Have dinner with someone just to talk about the places and get out and visit places with them too. If it's a matter of just, “hey, I'm in this single family home and I can't take care of it anymore.” There are lots of maintenance provided communities that have this active homeowners associations that they can get involved with. It just depends on the person. How do you know when it's time? If they're calling you a lot or you see a change in their weight? You see a change their attitude and their depression. Those are indications for me, it's all situations. A lot of it is social, not just physical.

Peggy Shults? 47:28??- And I will add to that I think some of our elders have an outdated impression of senior communities, or “the home”, as they often call it. “So I guess it’s come to this, this is where you're gonna put me.” So it’s kind of understandable that they really don't want to go. They're not familiar with what their options are in terms of communal living these days. And yes, it can be expensive, so that is a factor. But many communities will offer opportunities to come have a meal there, maybe stay for a day or two, and kind of get a sense for what it's like. They may be surprised by the potential for nice neighbors and things to do. Perhaps they’d see that it? might not be so bad. But I will tell you that we see too many times in our business where we are helping someone move into a senior community, and they have waited too long to do it. They're now in a community where there's a lot of things going on, but they've waited so long, their health challenges prevent them from taking advantage of all of that. And so perhaps in conversation you might discuss the advantages of moving while they can still enjoy some of these things.?

Audience member? 48:49??- I can just chime in. I work in the industry. And that was actually one of our biggest challenges just trying to help people understand that it really is not the nursing home that their aunts and uncles were in. I always encourage folks to think about what they're gaining. It can be helpful actually because there are other people out there, you know receiving care. If you are proactive about it, if you do the right community, the right situation, it can be good. And all of those things are supportive, nutritionally, spiritually, socially, emotionally, all of those things attached to that community. When you put pencil to paper, it really can be very, very affordable.

Audience Member 49:19

This is another question. It's about what we talked about before with parents living at home. My parents are still living there, but you know, I'm watching them like, really struggle. What’s the next step? I see you are struggling, but are you really in that place where now I need to drain your assets. You know, like, I think the quality of their living right now is nice, and certainly not as nice as what they left when they downsized. Now they're fearful of now going to a $h*# hole. That's the next step. That’s where they are. They don't have long term care insurance and they don’t have a lot of resources. So I think you're at that point you start dreaming. It’s depressing, you know, about other solutions that we didn't know, or anything out there that we don't know about. To make that next step. So it can still be a nice step.

?Angela Kreps? 50:58??- We're gonna take that one, and then we're going to take this one.

Audience member? 51:03??

The thing is, my parents moved into a well-established continuous care facility, the Independent Living fabulous, amazing. I was like, I'm reading all this stuff. It's incredible, except that they didn't pay attention to the nursing assistance, because it is crap. And that was the experience when my father was passing out there. But now do I put a deposit somewhere else? My mother, she could never have been ok with that. And so I'm dealing with what do I do now? Because I signed this flippin contract. I mean, end of life, hospice is likely covered by Medicare. And I highly recommend St Luke's hospice for that is why, but that's why I'm having people come in every day because I have not been moved to their facilities and it's clear to me that they weren't looked at. It was horrible. “I'm not gonna worry about that. They'll fix that up.” Well, they haven't. It's horrible.

Angela Kreps? 52:23??Ok. Let’s take those two things.

Kirsten Schroeder Larsen? 52:26??- I'll jump in. I think a lot of the care issues may have already existed, but certainly has been compounded and made much worse by the last couple of years. That's what we experienced. And it is heart wrenching. Trying to find a place because the price you're paying does not match in any sense, what you think you should be getting. Even if you're looking for that reasonably priced place. So it is really hard and I don't have any great solutions. As long as they have some degree of physical health, I think there are a lot of stopgap measures with private nursing, home health care. Health care and companion care that, while it certainly cost money, it can extend their stay in the independent living side.

Audience member? 53:29??

And it is so hard when you're going there to kind of look at the future. I really feel like that's really hard to see long term, not just today, again, financially. All of those things are really key questions to us. But there aren’t ways to navigate that process.

Angela Kreps? 53:53??- Let's get Brandie’s weigh in. The food’s here and we have a chance to network and dig into these personal situations, one-to-one.I know some people have to leave right at six o'clock. But let's get to it.

Brandie Gholson? 54:08??- I was gonna say that there are several things that you can do. One is making sure that you go ahead now and start visiting and trying to visit right now. Places that she would have to go to if it got to the worst-case scenario. And if you start looking now and you actually do kind of what they did not get to do in the incident, then that will help you tremendously. Because you're looking now mom and you both agree that okay, this is a great place like we see how everything was on that day, that's a rainy day, you know, just things that you want to make sure just like when looking at real estate, you want to make sure that you do the things and you go in, but they don't expect you don't schedule a tour just kind of step by. Second I would definitely also look for places that actually do take Medicaid. They will all tell you that but not all of them do. There are some places that have Medicaid pending that will actually place the Medicaid and let their Medicaid services up until about the remainder of their lives. You just have to search. Reach out to us for our help at any juncture when it comes to that.

Terri Monrad? 55:20??- That's where I am with my in-laws. He's passed away now and she's not at a place that will take Medicaid if she lives too much longer. So we're already starting the process of looking at long term care communities, because it’s usually best to be living in the community before you run out of money. The are more choices the earlier you begin.

Angela Kreps? 55:42??- Thank you. So if you have more questions, we are holding another one of these events on November 9. But take this opportunity while they're still here for the next 20-30 minutes and connect with them or connect with the other people in the room who, maybe you're in your similar situation. And you can go to the Aspyre site to access the Blueprint for Caring for an Aging Loved One (link in comments). It's just a way to get started, like a big checklist to gather these documents, think about starting to have these conversations, etc. I want to thank you all for coming today. Thank you so much to the Aging Parent Answer Team. I mean this was more amazing than I thought. It's not surprising. I’ll give the last word to Lucas Bucl with Aspyre to thank our sponsor, BlackRock.

Lucas Bucl? 56:51??- Thank you to James and Blackrock for sponsoring the event. You have been a great partner that we've worked with closely in our investment portfolio. They graciously agreed to support us tonight. Enjoy the food and drinks that are available here. Take care everyone.

Transcribed by https://otter.ai

SESSION TWO

Aging Parent Answer Team, sponsored by PIMCO

November 9, 2022 - Pinstripes, hosted by Aspyre Wealth Partners

Angela Kreps? 00:00 - Welcome back to this session with the Aging Parent Answer Team, hosted by Aspyre Wealth Partners? and sponsored by PIMCO? investments. We are joined by 5 panelists, sharing expertise in insurance, real estate, elder law and estate planning, downsizing and senior move management, as well as home care and home health care. Let's start there with Brandie Gholson on how to get started with mom or dad. Any suggestions, Brandie?

Brandie Gholson? 00:17 - We want to make sure that we are doing what mom or dad would like to be done as opposed to waiting until something bad happens and there's no choice in the matter. So we ask them what they would want when things start happening to our parents. That's not to say that they won't live past tomorrow, but you want to make sure you understand what things they really care about. My friend Dawn has a good way to get this started. Dawn, You want to share your idea for how to get at that?

Dawn Crouch? 00:39 - Dawn Crouch at Safe Oasis Insurance Well, I think that everybody should have what I call their never-ever discussion with their family and talk about what they “never ever” want to see happen. And then from there, you back into like Okay, so what would we like to see happen and make yourself some roadmaps of, okay, well, we want to die at home. And this is the resources that we have to accomplish that, and these are the services we would hire to make that happen. And if that becomes impossible, then these are the two or three assisted living facilities that we would feel okay with. Have your backup plans in place, way ahead of time.? Having a Geriatric Care Manager involved in part of that would be really smart. Because if one of the spouses passes away, and they were the caregiver for the other one, sometimes the kids really don't have any idea of what's been going on and the Geriatric Care Manager can be taking care of things at a really granular level, like who the doctors and physicians are, and what the plan of care is, in addition to mom and dad want to go to Silverado if they can't stay home. That sort of thing. It's important.? I think all five of us love this point. Have some sort of discussion with the people you love as early as possible, and talk about the uncomfortable things. That kind of conversation will set you on such a different path for the years you have ahead of you. You can avoid so many crisis's if you just start having that initial conversation. And even if your only outcome is to determine I don't ever want this to happen, take the steps necessary to make sure that it doesn't, whether that's the proper legal documents the proper insurance documents, having the conversation with your financial adviser, those kinds of things. Is that what you're alluding to?

Brandie Gholson? 02:34 - That's the one. This is the never ending conversation.

Kirsten Schroeder Larsen? 02:40 - Things change because things change for your parents. And things change for you, as a child who's going to take care of your parent or parents. Because you grow and change and mature and see things differently. That first time you have a conversation with your parents - it's probably uncomfortable for everybody. And so the thought going through your head is,? "I want to get through this as fast as I can." Okay, mom doesn't want to go to a nursing home. Got it. You want to talk about it again in a few years. When maybe you've seen some of your friends go through this and you've got a little different perspective. For what we've all gone through these last two or three years that has completely changed the world that we live in and changed what we expected to have available. Nursing homes, senior communities, whatever you want to call them. They are not the same as they were before. 2020 staffing is different. So if you had an idea of where your parents wanted to go - go check it out again. That would be based on my personal and recent experience, that would be a really good thing to go do because it may not be what you thought it was.?

?Terri Monrad? 04:58 - And know that when they do go to a senior care community, that they have to have an advocate there. Especially if they're in assisted living or long term care. There needs to be checks and balances. They need us, and if they can't have you there, they can have a geriatric care manager, for example. My soon to be daughter in law was taking care of her grandmother in Colorado from New York. I reached out to Peggy because I was looking for a senior move manager, and geriatric care managers, because she was her grandmother's sole survivor. It's very important to have eyes on the place they are going to when you can't be there in person.

Angela Kreps? 05:31 - Does anyone have guidance on when is the best time to move a parent? Someone in the audience mentioned that their mother is pretty stubborn about not wanting to move.

Audience member? 05:31

She doesn't even want to talk about it. So I am concerned something is going to happen and we won't know what to do. Mom is concerned about saving every penny.

Peggy Shults? 05:33 - When we are called by family members, it’s typically because it’s become pretty clear their parent is no longer able to care for themselves. They’re not eating well.? They're not able to take care of the home at all. It seems like it's become kind of an unsafe living situation. Or they have some sort of a health care concern. "You gotta take your meds on time and it's not happening," or something like that. A lot of times for the older folks, the reluctance to make a move is because in their head they're thinking of a nursing home or "the home". Their picture in their mind is a different long term care situation. Sometimes just giving them an opportunity to experience what they're like now can help. We sometimes hear people say, "My friend moved to a place and I'm kind of surprised. It's nice!" So sometimes giving them an opportunity to go visit places helps. A lot of these senior communities will offer an overnight stay to just come see what it would be like. Have a meal in the dining room. Sometimes they're kind of surprised. This is different from what they expected.? But there are some individuals who are diehard. "You are going to carry out feet first from this house."

Audience member? 07:07 - Yes

?Peggy Shults? 07:09 - That can be really hard because we want to care for them. We're worried about their safety. But they're worried about their independence. People of any age always have the right to make bad decisions and that's hard to watch.? But there's some dignity involved in allowing that person to go the way they're determined to go. I'm have power-of-attorney for my 97-year-old aunt who lives in Minneapolis. She's still living in Independent Living. She refuses to move to assisted living. And shes lucky to be able to afford to pay for someone to come and stay with her and do things. At 97, she's gonna choose. This is what's important to her. You gotta tell yourself, by allowing them to live the end of their life their way, you're honoring them.

Audience member? 07:29 - It is. It just makes the burden really heavy.

Peggy Shults? 08:09 - It does.?

Audience member? 08:11

I think one of the things for her is that the only thing she still has control over is her money. Because she can hardly see at all anymore. We're all taking care of her finances. But, you know, she wants to know how much you know, which is fine, you know.

Peggy Shults? 08:31 - Control is the key word there. They're hanging on when they're losing so many other things. "By golly, this is my place."

Audience member? 08:34 - Yes it is. Yeah?

Peggy Shults? 08:40 - "I belong here." "I feel safe here." And so it can be very hard.?

Audience member? 08:47 - Right.

Terri Monrad? 08:47 - When they think about the cost of assisted living. They no longer have a mortgage. They just have their expenses now. So that $6,000- $5,000 price tag sometimes is just unsettling for them.

Audience member? 09:04

The only thing she has control over is she wants to save all of her money for her kids. Not really realizing that her kids, maybe don't need it. They want her to be cared for with the money.

?Kirsten Schroeder Larsen? 09:06 - One conversation you might try to have is, if she's obviously concerned about her kids she wants to provide for them, just trying to convey to her that by not allowing you all to take care of her in the better way, she's making it harder for you. She said she's making it harder for you

Audience member? 09:45 - Yes

Kirsten Schroeder Larsen? 09:49 - She would take care of YOU better if she let you take care of her.

Audience member? 09:56 - That's a good way. I think we're just gonna have to all sit down and have the conversations.?

Peggy Shults? 10:00 - Perhaps she's the kind of person that might respond to: "What if something were to happen -- say you fell and broke your hip or something, and you had to go somewhere. If we don't think now, Mom, about where you might like to go when you get discharged from a hospital, you'll wind up going wherever there’s a room available. And that might not be where you would have preferred."

Audience member? 10:22 - Right.

Peggy Shults? 10:25 - So maybe she would be open to the idea of trying something while she has the luxury of time to make sure it's a place she likes. She can choose a floor plan that suits her and make sure she gets the things there that she cares most about. Then there would be time for that place to become familiar and feel like home BEFORE she gets to the point where she can't choose a place for herself.?

Dawn Crouch? 10:46 - I want to ask Brandie. I'm not sure if you heard the question.

?Brandie Gholson? 10:52 - Somewhat

?Dawn Crouch? 10:55 - One of the things (the audience member) mentioned was that her mother's losing her eyesight.

?Audience member? 11:00 - Almost totally blind

Dawn Crouch? 11:03 - Can you talk to us about what kind of therapist, maybe an occupational therapist, could help? I have a feeling that if I lose my eyesight, moving to a place I have never lived before scares me.

Audience member? 11:18 - That's part of it.

Dawn Crouch? 11:19 - If you move me someplace new, I'm gonna bump into everything. So is there some occupational therapy or something that could help with that??

Brandie Gholson? 11:30 - Absolutely. That's a great question. I have another question for her and then I'll answer.

Audience member? 11:39 - Yes, sure.

Brandie Gholson? 11:40 - Do you know whether your mom has Medicare?

Audience member? 11:40 - Yes, she does. She has Medicare.?

Brandie Gholson? 11:42 - Ok if she has Medicare, the Medicare service is paid for 100 percent by Medicare for her to get home health. Now there's a difference between home health and home services. You have to distinguish between them. Home health is nursing, physical, occupational, speech, and also social work. There in the home. So basically everything to keep the person OUT of a nursing home or rehab center. They can do it at home. It's just a matter of making sure it is the best route for the patient. Nine times out of ten, people want to be at home. So if they're able to do it on their own, that's great. If? right now she's having challenges with her eyesight, occupational therapy would be something that she can get.? What she should do is talk with her doctor. Just give her doctor's office a call. Let them know because they probably are already aware, "hey, she's been having some challenges when it comes to her eyesight. It's been declining can we get home health services?" Then they should be able to do that for you. They can write a prescription order for that and then home health services come into your home and actually give her the help. If you need any help with that, definitely give us a call. But if you have any questions on certain services, I like to give people choices on where they can go. I recommend people who offer really great services and take care of people, and do a great job.

Audience member? 13:28 - Thank you.?

Brandie Gholson? 13:29 - So that's one of the things we want to make sure you all know: You're not alone. You now have answers to some of the questions that you maybe did not want to ask. Or were afraid to ask or you just don't know who to ask something.

Dawn Crouch? 13:44 - Now, I want to ask (the audience member) a question. Do you have siblings?

Audience member? 13:47 - Yes, I have two brothers

Dawn Crouch? 13:48 - Ok so there are two brothers involved in this. One other hint when trying to assist a parent is that the division of care is never equal. Most parents have a deep desire to prevent their children from fighting amongst one another. So if you come at this from a never-ever of, "Mom, you did such a good job raising us and we love each other and we have a good relationship. This is the one potential thing in the future that would make us tear our hair out and fight with one another over how to care for you. If YOU don't express how you want to be cared for first." So that might be a way to kind of shift that conversation to HER again. It's her being the mom, which is the role she wants to stay in.

Audience member? 14:36 - Right. And having control.?

Dawn Crouch? 14:38 - Yeah, she wants to be the one that has the say on what happens. She might not see what's coming.?

Audience member? 14:45 - It's true.?

Dawn Crouch? 14:46 - So give her that favor, put her back in charge.? Ask for help so you don’t go down the rabbit hole with the three of us not talking anymore.

Audience member? 14:56 - It's good point.

Angela Kreps? 14:58 - Does anybody else have a question? I have more questions in the box I can ask.

Peggy, how can I help my mom see that she is taking too much stuff to her new, smaller home?

?Peggy Shults? 15:29 - Hopefully by the time you're having these kinds of discussions, you have a pretty good idea of where mom is going. Anything you can do to make it real in terms of how much space there is. For example, "In your closet, Mom, we've got 14 feet of space that we're going to have to hang your clothes. So let's look in your current closets."? And you mark off 14 ft. "Whatever will fit in this closet is gonna fit in your new space. So how about we start rearranging the things you want to take?" Because most of us can't picture how much space we really have, so if you can help them visualize it, it’s easier for them to understand.? And resist saying things like, "Mom, you don't need this." Because that makes her want to fight. "Yes, I do. You're not going to tell me I can't have this." Instead, ask questions. "When's the last time you used this?" She might think "Oh, you're right. I really don't anymore." Anything you can ask to help THEM arrive at their OWN decision that maybe they don't need to take this is really good. When all else fails, and they want to bring it, sometimes you gotta let them do it. When you get there, they'll see. That's okay. Help them deal with it then, if they’re willing. Try to avoid saying, "I told you so," if you can.

Kirsten Schroeder Larsen? 17:14 - Sometimes they don't. They just live in a crowded space for a while.

Terri Monrad? 17:19 - They go to the dining room every night, but they still have all the place settings and silverware and glasses. It's all there and we've moved it from one assisted living apartment to a smaller assisted living apartment. It's still there.

Kirsten Schroeder Larsen? 17:33 - There are ways to consolidate things and still keep things like photographs. "Let's put all the photos on a DVD so you can watch it every night. But we don't need to keep a whole bookshelf full of photo albums.

Peggy Shults? 17:47 - And you don't have to keep all the place settings of your china. Keep two or four.

Kirsten Schroeder Larsen? 17:52 - And use them. I think one of my favorite tips that you mentioned one time was to stop saving them for nice. Use them every day and put them in the dishwasher. When they look bad, pull out the next set.

Angela Kreps? 18:11 - Ready for the next one?

My dad is a veteran. Won't the VA pay for his care?

Dawn Crouch? 18:20 - Okay, we will tag team on this one. So, the veterans program does provide what's called aid and attendance. But there's some pretty strict parameters that you have to fit in before that's actually payable to you. And one of them is that you have to have been doing active duty during a declared war for at least one day. A lot of the wars that we've been in in recent years were never declared wars. I think Korea was the last one that was actually declared war. We've got a whole generation of people that have served in the military - who have been all over the world doing all kinds of things - and they may not qualify for some of these things that their parents did. Even though they served. That's my first hot tip. Be careful with that.? The second is, it's means tested. So if you're a wealthy veteran, veterans benefits aren't going to benefit you at all. Just know there's some trickiness there. Anyone who's been in the military knows that navigating military benefits is a world of its own. Encourage them to contact their local department and really get involved with someone who knows how to do that. It's not that much. I think the maximum is $2,000 a month or something. It is not a huge amount of money, even for those who don't have means, and who qualify for all the different particulars.

?Angela Kreps? 19:55

So if somebody's a veteran, they shouldn't necessarily plan to disregard Long Term Care, thinking, "I'm not going to need it." Correct?

Dawn Crouch? 20:02 - Yeah. Anything you want to add to that, Brandie?

?Brandie Gholson? 20:06 - Exactly. Right. And making sure that they understand that. Even when they aren't using their benefits. They need to make sure that they sit down with somebody who can tell them specifically where they understand it. Before they even need assistance. This is the same as getting help with hospice or home health. Making sure you know what you have prior to needing it, because a lot of people don't know the type of benefit they have. The type of benefit you have is going to navigate your care. There are certain folks who have those benefits that, yes, they will pay as if it were like having Medicare. However, if they are somebody who makes a certain amount of money, that is definitely going to be limited.? Then I also want to add there may be a benefit for spouses of a military vet as well. A lot of people don't know that. Once the vet's spouse begins to decline in health, their spouse may be able to get a certain amount of money to help out with their health care as well.

Dawn Crouch? 21:18 - I'm high-fiving you right now.?

Brandie Gholson? 21:19 - If you have a veteran as a parent, make sure to ask questions NOW about what benefits are that and what that entails. Dawn and I have people to help out with that specific information if you need it.

Angela Kreps? 21:40 - Thank you. Maybe we have just a few more questions, maybe a couple or three. And then we'll allow some time for people to network and say hello. What other questions are out here? Otherwise I could get a lot of questions in the box.

Audience member? 22:00 - I have one just kind of a follow on.

You mentioned Geriatric Care Coordinator a couple times. How does somebody like that get paid? Is it like a consulting fee? Do they get a placement fee? How does that work?

Brandie Gholson? 22:14 - There are some who actually private pay. You pay out of pocket and it's tailored towards you. They are not cookie cutter. There are definitely many service services. If you're looking for placement for mom, there's actually a place called, "a place for mom," to help out in that manner. They don't get paid by you. It's a service that's not paid by you out of pocket. It is paid for by the community where your loved one gets placed. We try to share choices of which one to use. We try to share some that are free services. We also share some that are paid and we let you know that ahead of time.

Dawn Crouch? 23:05 - I think when I first ran into some geriatric care managers, the term that came to mind was: daughters-for-hire. The kind of person that if you're out of town on a cruise, and you're the one who usually checks in on your mom twice a week, you can hire them to do that while you're gone. So it can be just a short engagement like that. Or it can be someone like you said. You've got a daughter-in-law coming from New York, who's got someone that she's managing in Colorado. Having someone on location, actually check in on her and able to report back.

Terri Monrad? 23:38 - And someone to go to the doctor's appointments.

?Dawn Crouch? 23:40 - Yeah

?Terri Monrad? 23:40 - You might need someone to hear what the doctor has to say and report back, so you can understand what's going on.

?Dawn Crouch? 23:46 - So the scope of how you can hire someone, it's flexible. It's really broad. And they'll charge accordingly. But it is not something that's covered by insurance.

Audience member? 23:56

Is that available in this area?

Dawn Crouch? 23:58 -- Yes it is.

?Angela Kreps? 23:58 - Great topic for networking. Time to exchange information about those services.

The next question is for Kirsten. My parents had a trust but we still had to go through probate. Why? #elderlaw #probate

?Kirsten Schroeder Larsen? 24:21 - Unfortunately, many people spend a lot of money and get wonderful estate planning documents, including a trust and don't follow up with the next step which is: funding the trust. You have to get your assets in the trust or directed to the trust with a beneficiary designation transfer on death, some means like that, or else the only way to get it into the trust is to probate that asset.

?Angela Kreps? 24:51

So when you say fund the trust, what does that mean? #trust

?Kirsten Schroeder Larsen? 24:55 - Think of your trust as a bucket. You want that bucket to hold the assets. You've got to get them in there. So that means changing the ownership of the asset or the beneficiary designation so that it goes there automatically.

?Angela Kreps? 25:11

It must say payable to the trust of whatever on whatever?

Kirsten Schroeder Larsen? 25:15 - Right. If it's not titled or directed to the trust, the trust remains empty, wringing its hands with nothing to do. Waiting for something.

?Audience member? 25:28

Can you just talk about what the benefits are of having everything in the trust?

?Kirsten Schroeder Larsen? 25:33 - One of the benefits is the ability to avoid going through probate. Probate is not bad in and of itself, but it is a public administration of an estate. There's certain timelines, certain things that add steps that have to be done, and you have a judge involved in the process. If you have a trust, you've set up the rules of how YOU want things to go. And it's a private contract. Your successor trustee steps in when you're gone. They read the document, they see what the rules are, what they're supposed to do with your assets, and they just walk through the process.

?Audience member? 26:18

Kind of an immediate authority, right?

?Kirsten Schroeder Larsen? 26:20 - Right

?Audience member? 26:21

So does it have any tax savings benefits or anything like that??

Kirsten Schroeder Larsen? 26:26 - Generally, for most people, no. It's not going to, because right now, the estate tax exemption is so high, most of us are not going to have estate tax. But it can simplify the process and save on expenses. Administration wise.

Angela Kreps? 26:48 - We had to go through probate when my dad died. We spent a lot of money needlessly. The trust had expired because it was put together back in a time when they had an expiration date or they put that in because they wanted to have the flexibility to change their mind when the kids got old enough or something. So my dad was in the process of updating the trust when he unexpectedly died. Going through probate did cost a lot of money and took a lot of time. Two years. But I mean, it was good for my mom to have something to do.

Kirsten Schroeder Larsen? 27:26 - On the plus side. It's always good to find that silver lining.

Angela Kreps? 27:31 - That’s how I try to live my life. Other questions out there? I’ll get one from the box.?

Okay, This next one is for Terri. If mom doesn't want to move, should we consider a reverse mortgage or home equity loan?

?Terri Monrad? 27:47 - Well, if Mom doesn't want to move and Mom needs care, doesn't have funds to cover that care an no long term care policy. Then the house may be her only asset. Yes, you can get a reverse mortgage. It usually goes up to 80% of the assessed value of the home. There's an appraisal process. It's a loan, but she would get money to fund her care. It's either a fixed value, that's paid out all upfront, or it's a set monthly amount for a certain period of time.? What happens is when Mom passes or can't live there anymore, the house goes up for sale and then that mortgage is paid back to the lender for whatever they've paid out on the loan. So if they've paid out that $100,000 house, they paid out $75,000, then they're going to get that $75,000 out of the sale proceeds of the home. So this can help someone who does not have the resources to go into a community or if they need to have some help if they are living off Social Security and they need extra money.?

?Audience member? 29:10

What happens if it's a down market and the house sells for $60,000?

?Terri Monrad? 29:14? - It depends on … I don't want to get into advice. They might have to bring money to the table. So it depends on how it's titled, too. Yes, I’d say it depends on the title. The lender generally is not going to make a loan that doesn’t make sense for them. They're gonna look at potential lifespan. You know, that's what we did when I worked at Aberdeen Village. We were looking at how long people can stay.? Because we were a not-for-profit. We weren't going to kick people out if they couldn't pay once they got to long term care at the end of their life. The lenders are pretty smart. They're not going to loan more than they think they can recover. Today's market isn't what 2008 was. Yes. homes aren't appreciating like they were and probably won't for a little bit. But that wasn't sustainable. So you wouldn't need to worry unless something's really wrong with the house. They're probably sitting on a nice asset.

Angela Kreps? 30:45?? - That ends our questions for tonight. I want to thank Nick with PIMCO and Lucas Bucl from Aspyre. And especially, I want to thank our friends from the Aging Parent Answer Team. We will spend the next 30 minutes networking if anyone wants to take their questions to one of these experts on a one-to-one conversation. Thank you for coming.

Transcribed by https://otter.ai