FAMILY
What to Do When Your Parent Can't Live Alone
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GLOSSARY
Durable power of attorney
A contractual agreement between your parent and whomever he has decided should make decisions for him (usually a spouse or child) when he is no longer able to (or perhaps wants to).
Surety bond
Bond required to be posted by a court-appointed guardian or conservator.
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RESOURCES
There are new, strict Medicaid laws that make it a felony under certain circumstances to advise clients how to put assets beyond the reach of Medicaid, but there are still legal ways of doing it. Medicaid actually has a lien on the estate of any of its recipients to recover its costs first. However, there are estate planning techniques such as Medicaid trusts and ways to divide the estate so that the remaining spouse has to bear as little financial responsibility as possible for the Medicaid expenses of the deceased recipient.
magine the scenario: You visit your parents and are horrified at the state of their health and safety. Mom forgot the leftovers heating in the toaster oven. Dad hasn't shaved or bathed for days. It's role reversal time - you're the parent and your parents the children.
What's worse, your parents haven't created a durable power of attorney or health-care proxy documents.
If your father and/or mother have reached a point where they drift in and out of lucidity, it's critical that you have the appropriate documents for your state drawn up immediately. You should discuss them with your parent(s) and an attorney. For these documents to be valid, your parent doesn't have to be competent at all times. However, when your parent does have to be lucid at the time any documents are signed.
If these plans aren't in place, and you honestly believe your parent is incompetent and perhaps a danger to himself or to others, you're probably headed to court. A guardian and a conservator must be appointed. You should file a medical affidavit from the doctor stating that your parent is no longer able to make decisions independently. The doctor who signs the affidavit has to have examined your parent within the past 30 days and must attest that your parent can no longer make decisions independently.
You're just the beginning the process
Having appropriate legal documents is just the beginning. Many other steps must be taken to ensure this transition to a new phase in your parent's life - and that of you and your siblings - will be as smooth as possible.
1.
Inform your siblings, in writing, of exactly what you have observed that has led you to believe your parent is incompetent. Not including them in the beginning can mean big problems later, especially if you end up bearing all of the responsibility and are then criticized for the decisions you've made. Additionally, putting your observations down on paper will have much more of an impact.
2.
Talk to your parent about what they believe is happening. He or she could be well aware of what is going on, or may be in complete denial. It's important to involve him or her in the decision-making process as much as possible, even though he or she may not be the one making all of the decisions. This will empower your parent instead of making him or her feel like a child.
3.
Have your parent examined by the family doctor and a geriatric specialist. Key questions to ask:
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Is it safe for your parent to be living alone?
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What signs of dementia do you see?
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What is the prognosis?
Your observations, especially regarding dementia and the daily help your parent needs, are very important. If your parents live together, can one adequately care for the other without help? If your parent has long-term care insurance, be sure to take the policy with you and explain to the doctor that you're trying to determine whether he or she might qualify for benefits.
4.
Contact your parent's attorney. Hopefully, you already know there are legal documents in place, but many parents don't want to tell their children anything. There is an attorney-client privilege that will prevent the attorney from sharing information with you, but if you can provide medical documentation that your parent is incompetent, the attorney should work with you to give you the information necessary to petition the court for guardianship. Remember that you'll need a surety bond if you become guardian.
5.
Assemble your parents' financial information. Hopefully, your parents will have given you the name of their financial adviser, or told you where to look to get this information. You need to know their financial situation before you can make any decisions about housing. This can also serve to dispel a sibling's belief that he stands to inherit a huge amount of money, and you get the blame when there is little or nothing left after your parent dies.
6.
Now that you have financial information and the right to make decisions, you have the major task of determining your parent's living arrangements. It is very often a good idea to include your parent's attorney in this discussion, because he may very well know your parent's wishes better than you or your siblings do. Decide the best place for your parent to live, given the medical and mental condition and prognosis.
Use the Joint Commission of Accreditation of Healthcare Organizations Web site for information on long-term and home care, and the American Association of Homes and Services for the Aging Web site for information on state associations and choosing proper housing. Call your state Office of Elder Affairs, or the Eldercare Locator at 1-800-677-1116, 9 a.m. to 8 p.m. Eastern time. All of these can direct you to programs for the elderly in your area and help you set up a plan that will relieve some of the burden of caring (emotionally, physically and financially) for your parent.
7.
Paying for your parent's care: This can be the thorniest issue of all. How long will Mom's (or Dad's) money last? Is there a way to legally shield some of those assets for your dad when Mom dies, and have Medicaid pay in the meantime? How are you and your siblings going to divide expenses? An important note: The sibling who is the primary caregiver, especially if Mom is living at home with her, should get a "salary" for the daily work and emotional stress. One way to do this if there are several siblings: The sibling with whom Mom lives pays nothing, and the other siblings chip in the rest.
Dealing with the painful issues
Smart families already have planned to ease their worries - they have obtained durable powers of attorney and health-care proxies, a financial game plan and an understanding of the state's Medicaid rules and eligibility. Your parents should feel secure about what will happen to them when they can no longer live on their own. A flexible estate plan should take into account a worse-case scenario: Your father's Alzheimer's disease prevents him from recognizing you, but his physical health is excellent and his life expectancy is still good.
These are painful issues to think about and even more painful to deal with. Even if you have not planned in advance, the sooner you get started the better. The sooner you involve your siblings by trying to make every possible decision a joint one, the better the chances are that you and your siblings can be supportive family members instead of enemies, and that your parents will be able to live the rest of their lives with dignity. 
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