Family matters, part 1

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The process of educating myself more thoroughly about this subject, the legal and financial connotations of caring for one’s aging parents has been like opening Pandora’s Box; it’s a

very difficult subject and it can bring up many painful and stressing emotions. Before I get into it, I want to emphasize that every family is different. There’s no right or wrong way of managing these things, and each parent ages in a different way. The worst thing a son or daughter can do is feel guilty because he/she can’t take care of a parent the same way others do, if his/her relationship with that parent is not like others, or if they don’t get along. Every family, every person is different. What counts is doing the best you can.

Here are the various considerations and solutions to help one or both parents when it comes to medical care. The documents and decisions regarding your parents’ health may not have legal equivalents in jurisdictions outside the United States, or they might be different; they will also vary from state to state. Nonetheless, it’s optimal to be informed about their medical and mental health, as well as their financial situation when/if the moment arrives to take charge. Today I will cover the health aspects, and the financial and legal will be in the next blog post.

Distances
For those who live far from parents, know that you are not alone: living far from one’s parents is more common every day. Companies need to be conscious of the fact that a part of the staff will have family emergencies that imply travel. If your employer doesn’t have a family emergency policy that is clear on this subject, I suggest that you inquire about your possibilities of travelling without warning.

Furthermore, I suggest that you set aside a bit of savings to cover the expense of travelling at the drop of a hat, because it’s pricey.

Time is not on our side
Aging happens; oftentimes it’s our bodies that remind us that we’re getting older, but

sometimes it’s the mind that goes awry. According to the National Institutes of Health, about 50% of people aged 80 and up suffer some type of cognitive impairment. If you add to that the common mobility issues, and the added life expectancy of seniors today, it’s almost certain that at some point you will face managing the care of one or both of your parents. And, in general, most of them dislike the situation; nobody wants to surrender her or his own independence to others.

Who takes charge?
When there are several children and grandchildren, it’s possible that there might be more than one person capable of assuming these responsibilities. The best thing in these cases is to have a family talk, an open, honest one, where everyone can agree on who is willing/capable of taking charge of some of the needs that your parent or parents have as they age. This way, official affairs as well as communication among relatives is managed in an organized fashion.

Once agreed, it’s good that the person in charge update everyone else regularly of all the

medical and financial developments. This should be agreed from the start and let me clarify that this isn’t a matter of trust or distrust, but rather one of ensuring that the person in charge is managing everything honest and ethically. Sadly, senior financial abuse is all too common among relatives.

Medical care coverage(s)
When the care for one or both parents includes long term medical care, it becomes imperative that all doctors be able to communicate among themselves regarding that care. This is very easy when there is only one insurance involved, but not so easy otherwise. If you know that your parent(s) have two or more medical coverage types, be sure to contact all of them and provide them with a list of all the other doctors currently managing care.

Medical appointments
I don’t like saying this but, if possible, go with your mother/father to become acquainted with their medical situation. I have seen too many times in my own family and among friends that parents don’t want to worry their kids, or think they’re a bother. To this day, I can’t really decide if this behavior is altruistic or not, because it’s all too often that the patient understands that, if his/her medical situation becomes known, his/her independence will be at stake.

This is why it’s important to be present at least one specialist appointment, to understand their health situation and needs. Afterwards, if you have medical power of attorney, or your parents’ HIPAA consent (I will explain these later), their care can be managed directly with the doctors.

If you can’t be present at the appointments, you can ask your parent to record the

appointments with the phone. iPhones have a recorder called Voice Notes. If the phone is an Android, on Play Store you will find a very easy-to-use app called Voice Recorder.

HIPAA consent form
The Health Insurance Portability and Accountability Act protects the medical privacy of individuals. For that reason, in order to obtain medical information about a parent, he/she must sign a HIPAA consent form allowing you to be informed. A different from must be submitted for every US state in which the person receives care, and for the one in which the individual to be informed lives; this is very important for multi-state areas like DC or New York City, where there are several jurisdictions very close to each other.

Here's a general consent form, but check with your parent’s insurance to see if it has its own customized request form.

Advance directives and living will
Advance directives are the instructions that a person sets in place for his/her medical care in the event of becoming unable to communicate them in the future. Of all the documents related to a person’s care, these orders are the most important to the patient, as he/she should be the one choosing what kind of care he/she wants in case of being unable to say so.

A living will is a type of advanced directive that explains the wishes for care and treatment in case the person is unable to state them and is terminally ill. Living wills may be created online for free. Here is an example of one.

Both these documents can name a representative that will be allowed to make decisions in the patient’s name.

After explaining all these things, I want to give one small piece of advice. The most

important things as parents age are two: constantly communicating with them, and respecting their wishes as much as possible. My mother, for instance, had a lifetime set of wishes about what was to be done with her remains that we all knew, but she changed them in the last week of her life and we were able to follow through with the change because we made sure to ask her.

Whenever you are unable to comply with their wishes directly, the best thing to do is to explain the reasons why. There might be disappointment, and sometimes even angry disagreement, but ultimately even the most stubborn have to come to terms with unpalatable realities. 

In the next article, we will speak about the legal and financial connotations of taking over the care of your parents’ affairs. Stay tuned!