{"id":322,"date":"2010-11-24T11:31:31","date_gmt":"2010-11-24T15:31:31","guid":{"rendered":"http:\/\/www.finaljourneyseminars.com\/?page_id=322"},"modified":"2010-11-24T11:40:53","modified_gmt":"2010-11-24T15:40:53","slug":"the-journey-for-the-later-years-part-ii","status":"publish","type":"page","link":"https:\/\/www.finaljourneyseminars.com\/?page_id=322","title":{"rendered":"The Journey For The Later Years &#8211; part II"},"content":{"rendered":"<p>\ufeffby Lori Myers<\/p>\n<p>This is Part II of a series that informs about the realities  of living old in this country &#8211; a country where families may be spread  out over thousands of miles, where healthcare might be administered in  one\u2019s own home or elsewhere by strangers, where costs of healthcare and  home aides keep rising at an alarming rate.<\/p>\n<p>Part I told the story of Mike Moser whose father, a highly  regarded orthopedic surgeon, began to experience memory loss. When told  by Moser and his siblings that he needed to retire from his medical  practice, their father became defiant and angry.<\/p>\n<p>Moser made certain that his parents had long-term health  insurance, a welcome safeguard that would prevent the family from having  to make difficult decisions regarding the selling or redistribution of  investments, and a means that would make sure the healthy spouse would  have enough money for day-to-day living. But as it turned out, they  never had to use it&#8230;<\/p>\n<p>* * *<\/p>\n<p>There was no way for Moser to avoid it any longer. His  father\u2019s condition had progressed to the point where it would be too  dangerous for him to perform surgery &#8211; an opinion shared by a former  partner in the medical practice and some friends. It was up to Moser to  sit his father down and tell him. It was a task that Moser dreaded.  Around his parents he was always the kid. But now the tables were  turned. The son would be the one giving advice to the father instead of  the other way around.<\/p>\n<p>\u201cI was crying,\u201d admits Moser. \u201cI didn\u2019t feel like a son anymore. I  felt like the bad guy. I had to help them understand what the situation  was and what to do.\u201d<\/p>\n<p>Moser brought up two matters with his father. One was for him  to retire before he endangered his patients. The second was to move his  parents from their small New England town to San Diego where Moser  lived. This was not the first time Moser had <img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" style=\"margin: 10px;\" src=\"http:\/\/www.todaystrustee.com\/Newsletter\/2008_04\/images\/v1i2a1pic2.jpg\" alt=\"pic\" hspace=\"10\" vspace=\"10\" width=\"400\" height=\"298\" align=\"left\" \/>brought up the subject of having them move across the country.<\/p>\n<p>\u201cI had always encouraged them to come out here because my mother had leg and ankle problems,\u201d Moser says.<\/p>\n<p>Through the help of a realtor, Moser found some homes for his  parents to look at, but soon realized that they couldn\u2019t live on their  own. After apologizing to the realtor, Moser switched his search from  single-family homes to continuing care retirement communities. He and  his parents whittled their choices down to three facilities. One place  had a two-year waiting list after which his parents would have to take a  physical exam and have to qualify. That wouldn\u2019t seem likely based on  his parents\u2019 declining health. The second community was building new  units, which wouldn\u2019t be move-in ready until two years later. But the  difference between this community and the first one the family looked at  was that the health exam could be taken now without a re-test.<br \/>\n\u201cThe salesperson there had a father with the same disease as mine,\u201d  recalls Moser. \u201cMy mother was able to pick the unit they wanted and they  put $2,500 down. Two months later they had to put down an additional 20  percent.\u201d<\/p>\n<h2><strong>Taking Care<\/strong><\/h2>\n<p>Moser made sure his siblings &#8211; a brother in Maryland, and a  sister in San Francisco &#8211; were kept updated on all the activities and  decisions regarding their parents. He did the right thing, according to  Sara Krueger, spokeswoman for Sunrise Senior Living that operates more  than 440 senior living communities throughout the United States, Canada,  the United Kingdom, and Germany.<\/p>\n<p>\u201cAny decision about senior living, whether it\u2019s a senior  thinking about moving, or an adult child considering help for a parent,  should include communication with the entire family,\u201d Krueger explains.  \u201cKnowing how to recognize the right time for these types of decisions  comes down to the kind of living arrangement that is needed. Some  seniors choose to stay at home. Others require some kind of specific  care. While others consider senior living solely on their changing  lifestyle, such as escaping the upkeep of a house, or being with others  who have similar interests.\u201d<\/p>\n<p>Krueger says that many times, people make the choice about  living arrangements after an event such as a fall, stroke or when the  family is concerned about safety, as was the case with Moser and his  parents. It would have been better, she advises, for the senior to  benefit from some sort of assisted living prior to the event. Some <img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/www.todaystrustee.com\/Newsletter\/2008_04\/images\/v1i2a1pic3.jpg\" alt=\"quote\" width=\"271\" height=\"198\" align=\"right\" \/>residents  have excellent health when they enter assisted living, allowing them to  enjoy the social and service benefits available there.<\/p>\n<p>\u201cCertain states have rules that prohibit individuals with certain  medical conditions from living in assisted living,\u201d she says. \u201cIt\u2019s  important for consumers to begin exploring senior living options well  before they\u2019re needed, which provides the opportunity to visit several  communities on more than one occasion.\u201d<\/p>\n<p>The transition from one\u2019s home to an assisted living facility,  which sometimes might be in an unfamiliar locale but close to a family  member, can be difficult, but it can also be a positive one if it is a  good match for the individual. A senior\u2019s needs, both emotionally and  physically, as well as their expectations, need to be considered when  choosing assisted living.<\/p>\n<p>With that said, consumers need to ask a myriad of questions  before considering if the facility if right for them or their family  member. According to Krueger, the following are some questions that  should be asked:<\/p>\n<ul>\n<li> Will the community be able to provide the level of care needed?<\/li>\n<li>Have the team members\/staff been trained appropriately to care for those specific needs?<\/li>\n<li> Do I like the location of the community, in reference to my family, friends, or other places that are important to me?<\/li>\n<li>Will this community continue to meet my needs as they change over time?<\/li>\n<li>Will the community provide the services that I am looking for?<\/li>\n<li><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" style=\"margin: 10px;\" src=\"http:\/\/www.todaystrustee.com\/Newsletter\/2008_04\/images\/v1i2a1pic5.jpg\" alt=\"pic\" hspace=\"10\" vspace=\"10\" width=\"400\" height=\"429\" align=\"right\" \/>What kind of personalized attention will I receive?<\/li>\n<li>How is each resident\u2019s service plan determined? Are the services customized to each\u00a0\u00a0\u00a0 resident\u2019s needs and preferences?<\/li>\n<li>Are the team members\/staff warm when I meet them?<\/li>\n<li>Does this place feel homelike and a place where I would feel comfortable?<\/li>\n<li>Do I like some of the activities that they offer, inside and outside the community?<\/li>\n<li>Is this a place where I will meet people that have common interests?<\/li>\n<li>Do the current residents look well cared for?<\/li>\n<\/ul>\n<p>\u201cSeveral of our communities offer short-term stay options so  people interested in sampling life at the community have the option of  doing so without the long-term commitment,\u201d Krueger says.<\/p>\n<p>Moser and his family did the right thing by doing their  homework and taking tours of the facilities they were interested in.  Consumers should speak not only to staff members, but also to residents,  participate in an activity, and have a meal or two in the dining room.  Get to know the \u201cfeel\u201d of the building, the residents, staff, and the  community in order to make sure it\u2019s a good match.<\/p>\n<p><strong>The Legal Side Of Things<\/strong><\/p>\n<p>Advanced age also brings with it lots of paperwork and  questions about who makes the decisions about himself or herself and  his\/her financial affairs. As long as the aging and infirm parent  retains competency then all rights remain with them.<\/p>\n<p>\u201cThis can become a huge and acrimonious issue,\u201d explains Bradford N.  Dewan, attorney-at-law with Miller, Monson, Peshel, Polacek &amp; Hoshaw  in San Diego. \u201cThe healthy spouse often can act for and on behalf of  the infirm spouse. But if there is no healthy spouse then the children  may have to make a decision regarding applying to the court to have a  conservator of the person and maybe a conservator of the property  appointed by the court. This is an adversarial proceeding. The aging  parent may feel that he is fully competent to make all decisions,  whether medical decisions or decisions regarding his property. The  children may feel otherwise because of certain actions or inactions.\u201d<\/p>\n<p>This is where various documents can play an important role,  says Dewan. If there is a Revocable Living Trust, then if one spouse  becomes incompetent, then the other spouse can serve as sole trustee of  the Trust. With an Advanced Health Care Directive, the healthy spouse is  appointed agent to make medical decisions when the other spouse is no  longer able to make and express medical treatment decisions. With a  Durable Power of Attorney, the healthy spouse is the agent who can make  decisions regarding all property of the aging spouse, again when such  spouse is no longer competent to make decisions such as selling or  purchasing property, for instance. This issue of \u201ccompetency\u201d is often  the decision of two physicians or a physician and the other spouse.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" style=\"margin: 10px;\" src=\"http:\/\/www.todaystrustee.com\/Newsletter\/2008_04\/images\/v1i2a1pic4.jpg\" alt=\"pic\" hspace=\"10\" vspace=\"10\" width=\"400\" height=\"287\" align=\"left\" \/>\u201cCompetency\u201d  also comes into play if a spouse or parent refuses to enter an assisted  living facility or a nursing home. If competent, according to Dewan, a  person cannot be forced to leave their home and enter an assisted living  or nursing facility. If the parent refuses to go, then the child has to  consider the pros and cons of seeking a conservatorship, a proceeding  that can be emotional and very detrimental to the relationship between  the parent and the child.<\/p>\n<p>\u201cThe role of the attorney is to advise the child what the options are, including a conservatorship proceeding,\u201d says Dewan.<\/p>\n<p>\u201cAlternatively, the attorney may represent the parent in the  proceeding to present the case that the parent is competent and there is  no need for a conservatorship. At times, an attorney may be appointed  by the court to represent the parent.\u201d<\/p>\n<p>Dewan recommends that everyone should have the following  documents in order before proceedings of this type tear a family apart:<\/p>\n<ul>\n<li>Revocable Living Trust &#8211; This avoids probate upon death  and also if structured properly, can fully utilize each spouse\u2019s  \u201capplicable exclusion amount\u201d in order to minimize, if not eliminate,  federal estate tax. It also may provide a successor trustee so that a  conservatorship can be avoided.<\/li>\n<li>Pour Over Will &#8211; If a Revocable Living Trust is used, then  this document simply states that any assets that go through probate,  because they were not transferred into the Revocable Living Trust, will  \u201cpour-over\u201d into the Revocable Living Trust upon the conclusion of the  probate.<\/li>\n<li>Living Will &#8211; This allows an individual to state clearly  their directives and preferences regarding medical care when  incompetent. It relieves the family members from having to make those  very difficult decisions. \u201cBut a limitation,\u201d says Dewan, \u201cis that the  Living Will does not discuss nor contemplate all of the possible medical  conditions that may arise.<\/li>\n<li>Advanced Health Care Directive &#8211; Under this document an  agent is appointed by the Principal to make all medical decisions when  the Principal cannot. Thus the Agent will be able to make decisions on  behalf of the Principal in situations not covered by the Living Will.<\/li>\n<li>Durable Power of Attorney &#8211; The agent is given authority  to make decisions regarding the property of the Principal either when  the Principal is absent, traveling and\/or is incompetent and not  physically or mentally capable of making those decisions.<\/li>\n<li>Beneficiary Designation Forms &#8211; These forms dictate who  will receive the assets, such as funds in an IRA or pension plan, upon  the death of the Principal. These must be carefully reviewed to make  sure that the real wishes of the IRA owner will be carried out. \u201cOne of  the biggest issues is whether the assets will be distributed to the  designated beneficiaries on a <em>per capita<\/em> or <em>per stirpes<\/em> basis,\u201d says Dewan. \u201cThere is a very important distinction between the two.\u201d<\/li>\n<\/ul>\n<p>The best advice Dewan can offer, along with making sure all  paperwork is in order, is for the spouses and parents to begin  contemplating their later years and initiate some planning. Proper  planning, he says, will allow the power of decision-making to be  transferred in a desirable manner and to those specifically selected. It  will also avoid those adversarial proceedings of conservatorships, plus  reduce the stress and uncertainty related to medical decisions.<\/p>\n<p>\u201cWith proper planning, parents can make sure that their assets and  financial legacy will be passed down to children and grandchildren as  they desire rather than by the \u201cdefault\u201d rules of the various states,\u201d  Dewan says. \u201cProper planning will also result in estate taxes being  minimized if not eliminated.\u201d<\/p>\n<p>* * *<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" style=\"margin: 10px;\" src=\"http:\/\/www.todaystrustee.com\/Newsletter\/2008_04\/images\/v1i2a1pic6.jpg\" alt=\"pic\" hspace=\"10\" vspace=\"10\" width=\"400\" height=\"266\" align=\"right\" \/>Mike  Moser\u2019s story ends tragically. The year after deciding on the assisted  living facility in San Diego, his mother died suddenly from a heart  attack. The siblings decided that their father would receive better care  near other family members in Virginia and made arrangements for their  father to live there. But their father died three weeks later from  kidney failure as a result of Pick\u2019s disease, a degenerative brain  disease that causes dementia.<\/p>\n<p>Moser says that even though his father\u2019s long-term care  insurance was not used, he\u2019s glad it was there for him if he needed it.  His father also had a living will in place. Moser and his siblings  donated their father\u2019s brain to a medical school for research so that it  might help others.<\/p>\n<p>The family prepared as best they could under the  circumstances. \u201cYou need to plan in advance,\u201d Moser says. \u201cDiscuss the  options with your parents before there\u2019s a problem. With his dementia,  there\u2019s no way we could have taken care of Dad.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\ufeffby Lori Myers This is Part II of a series that informs about the realities of living old in this country &#8211; a country where families may be spread out over thousands of miles, where healthcare might be administered in &hellip; <a href=\"https:\/\/www.finaljourneyseminars.com\/?page_id=322\">Continue reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":318,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-322","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.finaljourneyseminars.com\/index.php?rest_route=\/wp\/v2\/pages\/322","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.finaljourneyseminars.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.finaljourneyseminars.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.finaljourneyseminars.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.finaljourneyseminars.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=322"}],"version-history":[{"count":3,"href":"https:\/\/www.finaljourneyseminars.com\/index.php?rest_route=\/wp\/v2\/pages\/322\/revisions"}],"predecessor-version":[{"id":325,"href":"https:\/\/www.finaljourneyseminars.com\/index.php?rest_route=\/wp\/v2\/pages\/322\/revisions\/325"}],"up":[{"embeddable":true,"href":"https:\/\/www.finaljourneyseminars.com\/index.php?rest_route=\/wp\/v2\/pages\/318"}],"wp:attachment":[{"href":"https:\/\/www.finaljourneyseminars.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=322"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}