Podcast: Pitfalls and Mistakes When Caring for Aging Parents

June 17, 2024 - In today's Lifetime Planning segment, Jim Puplava engages in an insightful conversation with Carolyn Rosenblatt from AgingParents.com. They explore a variety of critical topics related to caring for aging parents, including essential do's and don'ts. Carolyn highlights the importance of creating a comprehensive care plan, comparing home care with assisted living and skilled nursing facilities, managing dementia, addressing trustee issues, and much more. She underscores the necessity of proactively planning for these challenging situations, providing listeners with vital steps and considerations to navigate their unique circumstances effectively.

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Transcript:

Jim Puplava:
It's no secret that America is aging. And as we get older, we're running into all kinds of issues, everything from stubborn parents, fighting siblings, money worries, to legal and health questions. Joining us on the program is Carolyn Rosenblatt from AgingParents.com and, Carolyn, you know, one of the things that we're seeing more and more today, it's gotten a lot more complex. People are living longer, but we're running into issues of elder abuse, everybody from heirs to siblings fighting over money and abusing the aging parent. I don't recall dealing with this as much 20-30 years ago. Why do you think it's more prevalent today?

Carolyn Rosenblatt:
I think that it is prevalent today because A) people are living longer and B), they have lived a longer work life and had the chance to accumulate wealth, and C) there are a lot of people in the generations, our elders, who have not done so well and see themselves as being entitled to take from their elders.

Jim Puplava:
And so when you run into this situation, I'd like you to explain ways to avoid this issue as possible. A lot of times you'll see, for example, we know that women live longer. They're usually the survivor in a marriage. In women rely more on friends in family rather than professionals. Number one, why is that? And number two, the problem that arises in trying to rely on friends and family.

Carolyn Rosenblatt:
Well, with the older generation, you're right, a lot of women are the ones who survived the men. And in traditional marriages, which dominated our culture for a long time, the men handled the money and the women didn't know very much about it. And in my consulting practice, which deals with families who have aging loved ones, usually it's the adult children. Sometimes it's the spouse of that, that elder who died. They don't know what they're doing with money, and so they trust the wrong people. And I think also in families that were very traditional, if there's a son, that person, whether they're competent to do it or not, was always appointed the one to be in charge. If the aging parents couldn't handle things anymore, and that may not be the right person, but it's because it was a boy. They picked him. I've seen this over and over and over again where the sisters might have been much more capable. So that's part of it. The other part of it is that families are scattered. We don't all live together in the same household with an aging loved one as that used to be in our country and in many cultures still is. So people are what we call aging solo. They don't have any family around them. Maybe they're estranged, so they get connected to the wrong people who see a crime of opportunity as they begin to lose their capacity to handle money.

Jim Puplava:
Yeah, we've seen issues where, let's say, a niece or a granddaughter was named as successor trustee, and that granddaughter ends up spending a lot more money. And one situation that we ran into, the granddaughter bought a nice BMW because the idea was, well, it makes it easier for me to get to grandma's house. I mean, things like that.

Carolyn Rosenblatt:
Oh, yeah. All kinds of abuse goes on. It's really very sad, and it's a problem that I run into a lot in the work that I do. What I tell people is that, you know, while the kids are in their, say, forties or fifties, now is the time to have these frank discussions with aging parents, anticipating things that could go wrong so that you've covered your bases. You don't have the wrong person appointed as the successor to the parents in handling money. You have someone competent. You don't put three warring siblings who hate each other together on one document that supports supposed to solve the problems of handling money or the trust after the aging parent can't do it anymore. Those are mistakes, and I blame lawyers for some of them because the way they draft trusts is a very significant part of the problem. There are certain pet phrases that I just hate, and I spend a lot of time trying to persuade lawyers to not use those.

Jim Puplava:
When you get dealing with these legal issues, and I'm thinking of an issue right now, and this is one I run into, where you may have the siblings and heirs, let's say mom has got dementia or Alzheimer's. She really should be in a long term care facility where somebody could watch over her, make sure she's attended to, her medical needs are met. They don't want to spend the money, so they want to leave mom in the house and save the money. And so unfortunately, what happens is mom is really ignored and not taken care of.

Carolyn Rosenblatt:
Yep. And I call that vulture syndrome. They're just circling around waiting like vultures for her to die so they can get the money. And there are family fights over the refusal of one person, sometimes the one in charge of financial decisions, to pay for care. It isn't necessarily true that a long term care facility is always best. Some people do very well at home, but it's really expensive either way. Some of these care homes here, where I live in northern California, are charging $18,000 a month. Wow. And that's not for any skilled care. That's for what Medicare calls custodial care that Medicare does not cover. That's, you know, bathing, feeding, dressing, walking, making sure that they have something to do social during the day, there's no nursing care. There's no medical supervision, $18,000 a month. And at home, when they get someone to be with mom or dad or whoever, they don't know anything about hiring home care workers. I've, in fact, written a book about that because I've seen so much disastrous decision making by families when they are trying to stumble and fumble and become an employer of someone and the person that they've chosen, they haven't hired properly, they haven't had training, and they become thieves as well.

Jim Puplava:
Carolyn, how do you feel about in home care where, let's say, the wife is the survivor, she feels comfortable in their home that she's in. It's paid for. She's familiar with it. Having somebody come into the home to take care of that person versus, let's say, going into a facility.

Carolyn Rosenblatt:
I have mixed feelings about it because I've worked in facilities, I worked in nursing homes. I've sued nursing homes. I have an idea about skilled nursing, and I've been in many assisted living facilities, which is a different license. That's the one with no medical. It's social, mainly, and daily activities at home. When the person is familiar with the surrounding, the smells and sights and sounds, it sometimes works better. Many years ago, I participated in a research study conducted by the federal government to expand the Medicare benefit to allow people to remain in home rather than sending them to nursing homes or whatever. And they were thriving because the experiment of expanding that benefit included transportation to social service centers, senior centers, doctors offices, all of that. And it worked well. And of course, the federal government decided not to pay for it because it was too expensive. So Medicare does not provide that benefit. But I think for a lot of people who are maybe a little shy, they don't like groups. They're overwhelmed by too much stimulation. Having them at home with a home care worker is a good option. However, most home care agencies do not provide skilled care. There's a distinction. There's home health, which is skilled, licensed people, nurses, occupational, physical and speech therapists can come in. Medicare pays for that, usually only after a hospitalization and for a short time. And compared with that, we have the vast majority of agencies out there which are called home care agencies as opposed to home health agencies, and they're having a hard time finding enough workers. There is a labor shortage. Out of desperation, they sometimes hire people who aren't trained or qualified. Those folks are in the home sometimes with a demented or otherwise impaired person for many hours, unsupervised. And the agencies do not require that they become accountable on a daily basis for what the elder is paying for. So at agingparents.com we devised a form which is an accountability form. Every shift, the person has to check boxes and sign off on what they did. I mean, you know, you don't want to pay them $30 an hour to be watching tv for 6 hours. But that does happen sometimes.

Jim Puplava:
Is it an issue of the aging parents' health, whether they're ambulatory or are there health issues where it doesn't make sense to have them in their own home?

Carolyn Rosenblatt:
Yes. When there is someone who has limited mobility, they can't get up and down stairs. They are very forgetful. There's no one to watch over them all the time. And the family cannot afford the 24 hours, seven days a week kind of help. And they're able to find a smaller, maybe not so fancy place that does have good care, then it's better to put them someplace where it's safer to be. But it's a very individual decision, and a lot of it is driven by money. What can they afford?

Jim Puplava:
So assuming that you do have the money and let's say there's a history in the family of either dementia or Alzheimer's or some kind of ailment, if you were to structure and put together a plan that would avoid these issues, how would that plan look like?

Carolyn Rosenblatt:
You mean at home or someplace else?

Jim Puplava:
Either one.

Carolyn Rosenblatt:
Okay, well, let's start with home. Let's say you got mom. She's got dementia, but she still can talk. She has some trouble walking. She uses a cane or crutches or something like that because she broke her hip a long time ago. She can't remember to take her medicine. She can't remember what to do. If you put her in the kitchen, she'd leave the stove on or the water running. So having someone there all the time would be helpful. But they need what we call in the nursing field. That's my background, a plan of care. What happens first thing in the morning. And people at home who have dementia always need a schedule. It provides a kind of security. What time do they get up? What time do they eat? What's supposed to be the meal? Then when is the next activity? What time do they take a bath? Do they go outside for a walk? Can they take a trip to the local senior center for listening to music or maybe some kind of conversation with other people who are similarly situated? What do they do in the later in the day? Do they rest? Do they get another meal at a certain time? What should they be eating for dinner? What should they be eating after that? Anything? What are their favorite programs? What can they follow if they have dementia? Can they listen to music? Do they want to be read to? There are a lot of things that can help stimulate a person to enjoy the last part of their lives, even when they have cognitive decline, as long as there is appropriate structure and appropriate activities that are suitable for their level of impairment.

Jim Puplava:
And does that person necessarily have to have somewhat of a medical background? Because what if, God forbid, there's a heart attack or stroke or something, knowing what to do?

Carolyn Rosenblatt:
They don't need to have a medical background. And the vast majority of people working in the home caring for elders do not have medical training at all. What they do need is some training about how to manage people with dementia. Dementia is a symptom of a disease. The most common is Alzheimer's disease, and it is a slow destruction of brain cells caused by multiple factors. Everybody who has impairment has particular needs and doesn't necessarily have to have a licensed person to take care of them safely. What the people who come into the home do need is training that you can get online, some of it for free, to help you understand as a caregiver how to take care of someone whose behavior may become difficult. There are a lot of people with dementia who have difficult behavior, and, you know, the doctors want to give them a heavy duty drug to make them zombies, and then they become very easy to manage, but they have no quality of life. I think being with the person, however, they are being able to tune into whatever their particular mindset may be at the moment. Being able to help them find ways to enjoy things, to laugh, to experience delight in the sunshine or a bird or anything that could interest them. That's the key to being a loving caregiver.

Jim Puplava:
And, Carolyn, what can you put in place now before that situation arises? So that person knows that if they do get dementia or Alzheimer's or some debilitating type of disease, this plan will be put into place. In other words, avoiding the vulture siblings who are saying, hey, we don't want to spend the money, you know, let's just hope mom passes away and we get the bucks, right?

Carolyn Rosenblatt:
Well, it depends on how the trust is written, assuming there is a trust. And as for the listeners who aren't sure what that means, a trust, I can put it simply is like a box around your assets, and what's in that box is determined how to be spent by a trustee. The trustee needs to be someone competent and caring and honest if they're horrible at it. Other people who might be beneficiaries of that trust eventually can ask a court to remove them if they're abusing things. But assuming that that person is trying to do the very best, the lawyer who drafts the trust or fixes it later, which we call amending it, must put into place the specific requests of the person who has the money to start with, the trustor or the settlor, we call them. That person can say, and they often do, I want to remain in my home as long as possible. And they can say, I do not want to be placed in a care facility under these circumstances. And they can list them. And those kinds of provisions give particular guidance to whoever would be the next trustee to ensure that the elders wishes are met.

Jim Puplava:
All right, so let's take another situation. Instead of being cared for in the home, going into a long term care facility, obviously one issue is going to be finances. But how is this handled?

Carolyn Rosenblatt:
I think it's much more difficult because a lot of people want to put the elder in that home because a, they're too complicated to handle by family or that's how they see it, or they're already difficult. Stubborn personality. They've got dementia too, maybe some other things and the family just feels overwhelmed, or other people have been not a good parent and the kids do not want to take care of them and their solution is get rid of them. But long term care facilities are not a set and forget solution. There has never been a care facility that did not need someone watching over what they do. And I have been in more of them than I can count. When I was working as a student nurse, I was in nursing homes quite often because that's how I could pick up a shift and earn some money. After I got out of nursing school, I worked day shifts or per diem in various nursing homes and I saw how much neglect and abuse went on. I was sometimes the one person on nights as the only rn for 90 patients. That's a lot of resonance for one person to handle. So I think that even in assisted living, which touts itself to be more homelike and not hospital like, and we have caregiving, you have to really understand what they do there. They do not provide 24/7 attention to your loved one. You're lucky if you get several hours a day of anything that's in a group or with staff involved, there are very few people on duty at night. These facilities vary tremendously in their budgets, their staffing levels, the amount they're willing to pay people to be in charge. So it requires attention and vigilance to ensure that things do not go wrong in these places because they can.

Jim Puplava:
What can you do in terms of choosing a trustee? Because so many times we see parents will name children. Children are living in different states, number one. Number two, they don't have the financial knowledge on estate taxes, all the legal issues and financial issues that come up. So what would you do? Let's say you're setting up a trust in choosing a trustee. What are the important qualifications and what would you be looking for?

Carolyn Rosenblatt:
Well, first of all, we have to look at the family because that's what most adults want to do with their money, is have one of their offspring in charge. We look at the family has Sonny boy, who's the oldest son, who's dad's favorite. The fact that he had a drug problem and he's been unemployed ten times in the last five years, would that be an indication that he's not going to be a good trustee? Absolutely. If the family does not get along. And unfortunately at agingparents.com where we consult with families and mediate these family fights, there are plenty of families that don't get along. There's someone with a mental health issue. There's somebody with a financial dependency problem. There are a lot of things that come to light after years of being dormant when the elder is failing and the adult children have to step up. So I would never pick a fiduciary in a dysfunctional family if that successor, a trustee, is supposed to be the one in charge, and they're not very good at money. Okay. You've got to look for someone responsible. First of all, someone who's very honest. They are never going to do what we call self dealing under the law, that is illegal. Trustees and successor trustees working for somebody else are not supposed to do self dealing. You don't buy yourself a fancy car because it's fun to take mom to the doctor in the BMW. That's not what a trustee who's honest does. You take your own car and you charge the trust for the expense of maintaining it or whatever you're doing, but you don't reward yourself. Trustees in a family need to be people who are committed to carrying out the elder's wishes, regardless if they conflict with the person's own philosophy or wishes or desires for money themselves. So I think those are the most important qualities. Honesty, capability with money, willingness to commit to carrying out the trustees wishes, the elder's wishes. Beyond that, when families can't do this, it's better to go outside the family and pay. In California, we have licensed fiduciaries. These are people who are certified by our state to be able to handle money for other people. They're not always great at the job of managing care, but they can certainly manage money. So sometimes a cooperative arrangement works out where someone in the family, often the daughter who's used to caregiving, will handle all the medical and care decisions for mom or whoever, and the fiduciary handles the money. That's a solution that sometimes works. But the worst thing people can do is just pick a kid, because it's the kid without regard to whether they can do the job. And that's where things can go very wrong with successor trustees.

Jim Puplava:
One issue that we used with the client is we picked a corporate trustee to handle the financial issues and then one daughter that lived close to mom. So you had two people caring for mom.

Carolyn Rosenblatt:
Yeah. The problem I have with corporate trustees, Jim, often banks, financial institutions, they don't visit the elder. The law requires that they see them and that they attend to their needs. They don't even know the elder. It's all paperwork, it's all balance sheets. And, you know, my experience with some of them is they couldn't care less about what the elder needs. They question expenses, like having special individualized care, like, say, a concierge doctor, as opposed to just what Medicare covers. It's irritating, and it does not honor the individuality of the person whose money is paying that corporate trustee. So it's got to be somebody special that's known, that's willing to go make a home visit. And you find me one of those, Jim, and I'll be happy to meet them.

Jim Puplava:
We've found one. They're independent trustees. They used to work for major trust departments and they formed their own company, but they actually go out and visit the clients. We have three clients, all in dementia, and they actually go to the home and spend some time with them.

Carolyn Rosenblatt:
That's the least they can do. They're supposed to do that for the money. They don't get a reward for doing what they're supposed to. I'm glad you found them.

Jim Puplava:
Yeah, it was hard, but we found them, Carolyn, in sort of wrapping this up, if you were to come up with, let's say, three or four do's and don'ts, what would they be well.

Carolyn Rosenblatt:
Let's say we're talking now from the older parents point of view. What are the do's? First of all, be transparent. If you're afraid that talking about finances means your kids are going to take advantage of you or they're going to be unmotivated to work or whatever, get over it. You know, tell them I'm sorry, you don't get this till I die. But in the meantime, here's what I want, and make it clear what you want. If you want to stay at home, you got to think about the possibility that you might become cognitively impaired or physically impaired. We have to get over the great american fantasy that we're going to be perfect until we breathe our last breath at age 100 and we die peacefully in our sleep. It does not necessarily work that way, and most of the time it doesn't. So be transparent is the number one thing that I think is important. Number two, let's talk about what you want done with you when you can't fend for yourself, possibly. What kind of care do you want? How much of the budget are you going to allocate for that? Are you willing to spend what your kids might see as their inheritance on yourself so that you can be comfortable, safe and reasonably happy in your last days? That's a very important question, and people don't talk about it. You have to articulate what you want and be very clear about it. Yes, some of these oldest folks have lived through the Great Depression, and they saw people jumping out of windows when they lost everything. So money is a taboo subject. You don't talk about it. That is a hangover from days past. We have to change that and say what we want. Each individual has a right to say what they want done with their own assets, with their own care, but they have to address the question of needing care, and that's where the resistance comes. So I'd say do that. And the third thing is, think carefully and choose wisely. If you are picking a successor trustee to take over for you, should you fail in your health, pick that person with wisdom in your choice being, what are they good at? What are they not good at? Could I completely trust them? What if they were unemployed? Would they try to steal? Do they get along with the other people who have an interest in the inheritance as well? If they can't do it and you can't find someone, do not be afraid to pick an individual licensed fiduciary to save the conflict, to get past all the issues of siblings who may not get along or to relieve somebody who's really not very good with money of the burden of having that responsibility, and a licensed professional fiduciary who's independent. The way you found some, Jim, not working for a big corporation, working for their own little entity, that's a choice that a lot of people can make and don't know about.

Jim Puplava:
Carolyn, as we close, tell our listeners about your website and all the resources you have, books, articles, e-books, and you also talk about the threats and the various issues we all face as we age. Tell them more about that.

Carolyn Rosenblatt:
Well, I am a registered nurse and public health nurse by background, I've always had an interest in health. I'm also an attorney. I was a litigator for 15 years, and I do understand the court system. And I've been a consultant for the last 15 years trying to help families who are struggling with these age related issues. I'm a writer, so what I try to do is take some of the information that I've learned from all these thousands of teachers I've had as patients or clients and distill those into things that make it easy for people to grab something. For example, there's a checklist about the ten red flags of diminished capacity. Well, how do you know if it's not just mom's memory going and maybe that's normal? We distinguish what's normal and what's a danger sign we have books. My latest is hiring a home care worker. What could possibly go wrong? And that is about the process of hiring people to come into the home to be with your aging loved one or yourself, and knowing the right way to become an employer of that person so that you're protected from anybody being a thief or neglecting you in your own home. There are lots of books. There's the family guide to aging parents, which is a general discussion of a lot of these issues. It covers family dynamics, the normal aspects of aging, and nursing homes and assisted living facilities and family conflicts and so forth. That's kind of a general book. I've written others and have a number of things. But I think one thing that's useful for perhaps a lot of people is the checklist, which I don't have on the website yet. It's newly developed for public use. But when a caregiver comes into the home and they're getting paid by the hour, they need to be made accountable. Agencies that send them to you don't share with you what they do every day. And I think having an online form that the supervisor of the caregiver or the caregiver, him or herself can fill out every single day, every single shift. So, you know, what's up? Up. Did grandma take her medicine? Did she get a shower? Did she eat her food? Did she go outside for a walk? Did she make it to the doctor's appointment? What happened when she got there? All that kind of stuff can be done on a checklist. And I think those are important tools for people. But I think one of the most important services we offer, Jim, and when I say we, I'm talking about myself, nurse, attorney, and my husband, who is a geriatric psychologist. We consult with people to just help them figure out what to do. When you think about it, nobody teaches you how to take care of your aging parents in school. That's not what we learn. And all of a sudden, we find ourselves in these dilemmas because our parents are in their nineties or beyond, or maybe they're starting to fail in their seventies and we just don't know what to do. So we are an information resource place. We teach people strategy. We help them figure out what to do next. If there's an abuse or problem going on, we refer them to litigation attorneys. If there is a court appearance or request needed, like, say, a conservatorship or a restraining order against an abuser, all that sort of thing. So I think that people need a place to reach out to, and we are a place people can reach out to.

Jim Puplava:
All right. Well, the name of the website is called AgingParents.com. All one word, agingparents.com. Carolyn, thanks so much for joining us in discussing this very important subject.

Carolyn Rosenblatt:
Thank you for having me, Jim. It's always a pleasure to speak with you.

Jim Puplava:
That concludes my interview with Carolyn Rosenblatt, and I highly recommend you go visit her site, aging parents, because it deals with a lot of issues that we are confronted with today. A stubborn parent, you've got fighting siblings, money worries, legal or health questions. We're seeing more and more abuses today. So go to the site and think this through, because you don't want to be, be in a situation that you find yourself where you're aging. You don't have the proper care. You've got siblings that are trying to take advantage of you financially. We see this over and over again today. So do yourself a favor. The website is AgingParents.com. I'm Jim Puplava, thanks for listening.

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