Planning For Decrepitude

WHEN MY CHILDREN WERE pre-teens I would say, “Some day I will be old and decrepit.” This was a vocabulary building exercise, and the girls loved to say “decrepit”. But now, they are all adults. And I am getting old. I can’t say I’m decrepit, yet. I’m getting there though. But how do you plan for being ‘elderly’?

I have many friends who are in their 80s, and getting around very well thank you very much. They’re not decrepit. But most people I know in their late 50s and 60s have elderly parents who are chronically ill. My wife’s father, for instance is 96, lives alone and takes care of himself, walks with a walker, but just barely.

This is a housing problem. What does someone do to plan for the day when, try as you might, you’re suffering from some kind of disability most of the time and can’t take care of yourself or your home? Do you sell the house? Where will you live? Is in-home nursing care the best option, do you order meals on wheels? What will Medicare pay for, what can you afford to pay for nursing care, what are your options?

This is the first of a series of posts on planning for being a “elderly” homeowner in need of some advice and help.

Here is an outline of the planning all of us need to do as we cruise over the magic age of 55.

1. Prepare A Family Revocable Living Trust with Living Will and Durable Power of Attorney For Health Care.

2. Nursing care insurance is expensive, as is nursing care ($6000 per month for a nursing facility here in Santa Clara County), Medicare does not provide nursing facility benefits, but Medical, and some pension plans, do have nursing home care benefits, a plan for obtaining these benefits should be made if 24 hour nursing care is suddenly required;

3. Planning and contacts for home maintenance and household chores as well as modifications to your home to make it safer and more senior friendly;

4. Planning to save family assets, like the family home, or other real estate;

5. A plan if Assisted Living becomes necessary, contacts and choices for assisted living housing;

6. Veterans Administration benefits need to be checked because not only do Veterans have hospital and hospice care rights, but surviving spouses may have benefits as well, including burial benefits; and

7. Hospice care and burial planning need to be made. Many of us don’t want to think about “kicking the ol’ bucket” so we leave it to the children. Adult children immediately revert to age 12 when mom dies, and begin feuds with each other, so its a bad idea to leave the hospice care and burial plan to the kids.

In this series each of these topics will be taken up, with links to important sources of information, advice, benefits and services.

My plan, as I have said to my daughters, is to work to the last day, and then flop over dead. This is a good plan. But it doesn’t always work out the way you plan it. Women on average live 14 years longer than men. Anyone visiting a nursing home recently will recognize that the ratio of women to men in nursing facilities is at least 10:1. Planning for a long illnesses is more important for women. Men often do tend to hit the longevity wall at 73, and do often get round well until they flop over dead. Probate statutes say, “he” dies. Among couples nine time out of ten times, “he” does. The men who blast through the longevity 73+ wall often live well into their 80s, 90s, and even break the magical centennial birthday barrier.

Decrepitude planning should begin before your elderly. Don’t wait until you wake up in the morning at age 106 feeling like you’ve been in a car accident because of arthritis; forgot where your put your eyeglasses; can’t see to find the eyeglasses anyway; fell in the bathtub; left the electric range burner on and wonder if your getting Alzheimer’s, and can’t remember if you’ve taken your nitroglycerin heart medication to prevent a heart attack; insulin for type II diabetes; Coumadin for thinning your blood, and the arthritis medication and the pain killers. This is not the best time begin planning for being elderly.

Here is what you should have already done:

1. The Family Revocable Trust. This trust is a substitute for a will, but it is far more than a will because it provides for physical or mental incapacity, has a family Trustee who can take over your bank accounts and pay your bills, sell the house if they need to, and for someone you know, like a son or daughter, to easily manage assets in the event you’re incapacitated. The trust’s clause providing for incapacity is perhaps more important than the disposition of assets provisions in a trust. Strokes and dementia can come on suddenly, without warning. A revocable trust must be completed while your competent. It is too late if you wait until after a mentally debilitating event.

Revocable trusts and related estate documents are not expensive and typically cost between $500 and $3000 for a trusts and estates lawyer to prepare. Local lawyers specializing in trusts and estates can be found here.

Further, as part of the documentation, there is a Living Will providing for who is to make medical decisions (like admit you to the hospital) in the event you are unable to do so, and what instructions you have for medical care. In the event you do have Alzheimer’s (as one in eight of us will), or other dementia, following a doctor’s or doctors’ certification, there is a Trustee to step in an take care of you. And, of course, you talked to the Trustee, adult child, about were the Trust documents are along with deeds, car titles, retirement 401ks, and bank accounts.

A family trust will also help protect adult children from your medical bills. Today must hospitals try and get adult children to admit parents to the hospital, or to sign for medical treatments when parents are hospitalized. Then children also become liable for medical bills. A family trust allows the trustee, usually one or more of the children, to admit an ailing parent to the hospital as trustee of the trust, and thereby avoid personal liability for your hospital bills.

Most elderly homeowners believe the family home will be inherited by their children or heirs. This is not true for many. In fact, without a family trust the family home may well be sold to pay hospitals and lawyers.

Completing a revocable family trust is the easy part of planning for decrepitude. The next post in this series will explore the complex world of nursing care.

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