Making Decisions and Dealing with Issues as You Age

In this first ever Television broadcast from Aging Insight, John and Lisa talk about the progression that they see families deal with:  the health issues, financial issues and the legal issues that come into play with caring for a senior in the family.

Episode Transcript
John
Welcome to Aging Insight. My name is John Ross and I'm here with my co-host Lisa Shoalmire, and we're elder law attorneys. And we're bringing you this program to inform the members of our community about the issues that relate to senior adults, people with disabilities, the kind of issues that we see in our practice on a regular basis. Lisa, what does elder law mean to you? 

Lisa
Well, I get that question all the time when I say I'm an elder law attorney. And really we're talking about a particular client or a person that we're serving, as opposed to an area of the law. You see things like a criminal attorney or a bankruptcy attorney. Well, elder law is an area where we're focused on the client needs and we bring the different areas of the law in that apply to that client, particularly seniors and those with disabilities.
John
And one of the funny things about elder law is a lot of times I'll walk into a client conference and when I walk in the person I'm there to meet will look at me and say, "Well, you're not elderly."
Lisa
Right. They think that elder law means that you're an elder statesman or an elderly person, but really that is the area of focus. And so we want to bring the information that seniors need to dealing with protecting their assets, planning for long-term care issues, planning for their families when they're gone, those are the kind of issues that we deal with.
John
That's right. And so a lot of times it's a matter of mixing a lot of different pieces of the law. You've got wills and trusts, you've got guardianship and powers of attorney, you've got government benefits like Medicare, Social Security, Medicaid, Veterans Benefits, and you're combining all of these things together with maybe a sprinkling of tax in there as well.
Lisa
Even occasionally a little real estate sometimes.

John
Even a little real estate. But it's all about that individual and addressing that individual's needs. And at least the things that I see from people on a relatively routine basis, they're big concerns. They want to avoid going into a nursing home, if they can. They like to stay independent, they wanna stay on their own, they wanna age in place.

Lisa
Right. That's usually a big fear for our clients. That's also something that... These days, we have a lot of clients who may have gone through that journey with a nursing facility, with a family member or their parent or grandparent, and they don't necessarily want that journey for themselves.

John
Right. And so one issue is, again, they wanna age in place. They wanna stay out of institutionalized care if they can avoid it. The second big concern that we see a lot of people have is that they want to avoid becoming a burden on their family. They don't wanna be a burden on the people that they love. They've been independent for a long time, they've handled their own affairs, and the idea of burdening that spouse, burdening those kids, that's pretty distasteful to most of the people that we talk to.

Lisa
And of course a lot of family members, they don't necessarily look at it as a burden, but that senior they don't want that weighing on them that their needs are taking away from like that adult child's own family.

John
Right. And so the first big issue we see it relates to that staying out of the nursing home. The second big issue is becoming a burden. Nobody wants to be a burden on other people. And then the third big issue that we see people have is how are they going to pay for the care that they need and the fear of going broke.


Lisa
That's right. They don't wanna go broke. They don't want to run out of money to pay for their care and to pay for their living expenses. Most of our seniors, they are the pay-your-own-way kind of folks and that doesn't change as they reach that senior retired older stage, and that's a big concern.

John
It is. And that's what Aging Insight, this program, is all about. It's providing the information out there to you as the community to be able to give you the information that you're going to need. The answers to your questions as it relates to these things like wills and trusts, guardianships and powers of attorney, government benefits out there. If you are armed with the right knowledge and you understand how these different things are gonna impact your life, I'm here to tell you, it's possible to age in place, to not become a burden on your family, and to avoid going broke in the process.

Lisa
And the key to all of that is getting the right information, and using that information to be the captain of your own ship, and determine what you need to do to plan for yourself. So it's really important that you get that information from a reliable source, you get the correct information, and John, how many times do we have people come in, they have told us they've heard something from a friend, neighbor, somebody in their Sunday school class, and it is just absolutely incorrect?
John
Right. There's so many rumors out there, and we give a lot of presentations, we give a lot of speeches on these topics. And one of the things that I always talk about is that your aunt Sally doesn't know anything about any of this sort of stuff. And yet, the people who seem to know the least are the ones that are often the most vocal about it.

Lisa
Well, just because your neighbor down the street went through a certain situation, a lot of times people don't really share every fact with their situation, and so the solutions and the responses they came up with to address their elderly family member may not work for you.

John
Right. And so, I bet there are some rumors out there that you've heard. Things like you need to get your house out of your name, you ought to add your kids to your bank account, everybody ought to have a will. Things that, as you will continue to see as you stay tuned to the program, you will learn that many of these things are just in fact rumors. That you probably shouldn't get that house out of your name. In fact, you probably shouldn't have those kids on that bank account. There's lots of different pieces to this. And if you can take the information that we're providing, and use that appropriately for your situation, you're gonna be a whole lot better off.

John
Yeah, and that's what we're here for. That's what we're looking forward to doing, and getting you that information. And John, I think that when we come back in a few moments, we're gonna start talking about the progression that we see that families are dealing with as they deal with the health issues and financial issues and the legal issues that come into play with caring for a senior in their family.

John
That's right.
Lisa
Welcome back, everyone, to Aging Insight, our television program where we are bringing information to seniors about their health, finances, and legal choices that they have, and I'm here with John Ross, elder law attorney, and I'm Lisa Shoalmire. And we wanna talk about now what we see most commonly with our clients that really force them into making some decisions and dealing with issues. And so, really, John, what's the first thing that happens that brings a client seeking this type of information? 

John
Well, unfortunately, what we see often is that what has happened is somebody has had some sort of health event, a crisis. Now, when you think of the word crisis, a lot of times you think of something sudden, and it doesn't have to be, but it can be. For example, somebody might have a stroke. They might have a fall that has caused a significant injury, maybe even a head injury. So they might have had something sudden happen. But other health crisis can be progressive things like Alzheimer's disease, Parkinson's disease, things that get worse over time. But what happens is this health crisis, once you're in the middle of it, you find out a pretty hard fact, and that fact is that you cannot live the same way you used to. All of a sudden, you may not be able to go home.

Lisa
Yeah, suddenly, you may find that you have difficulties standing up for long periods of time to prepare meals or do the things that you used to do at home by yourself, and suddenly we're in a problem.

John
Right. And so you might need extra care in the home, you might need assisted living, you might not be able to live in the home at all in which case you might need some form of assisted living. You might even need skilled nursing care, what most people call a nursing home. And sometimes, we don't get to pick. We say we want this or we don't want that, but sometimes your care may dictate that at least for a little while you get the kind of rehab that is necessary in that skilled nursing environment.

Lisa
That's right. So, our clients end up dealing first and foremost with that health issue, whatever that crisis may be, but then it becomes apparent to them that that is going to lead to a housing issue, and that's usually the next step where we need to grapple with what we need to do and where we need to live.
John
Right. So your health crisis has now become a housing crisis, and the next thing you find out is how much all of these sort of things cost.

Lisa
Right. A lot of times, we've lived in our homes for years, it's paid off, we're happy as clams, right there it's exactly how we want it and we know what our bills are each month and we can take care of that, but suddenly that health crisis has led to a need for perhaps some in-home care. Maybe all of a sudden, you need that adult child who lives in town to be in and out of your home every day. Maybe you need to hire people to come into your home. Maybe you can't stay there at all because your home is not equipped to help you address the health needs that you now have. And so when you look at your options whether it's paying for in-home care, whether it's reimbursing a child for their time and expense and running around for you and doing things for you or it's moving on to an assisted living or another type, moving out of your home to another living location, it all costs money.
John
Right. And of course, we've got viewers who are sitting there at home right now and they're saying yes, but I've got good insurance, I've got Medicare, I've got TRICARE for life because I'm a retired veteran or I'm a retired federal employee and I've got Blue Cross Blue Shield or I've got all of these good insurances, and so they're gonna cover these medical needs." Well, what you find out is that if you need somebody to come and care for you in the home, for example, well, they might provide a small amount of healthcare-related coverage, a nurse for example to come and check your blood pressure or blood sugar. But if you cannot cook a meal, Medicare or your insurance is not paying somebody to come cook a meal for you.

Lisa
Yeah. And so we get into the situation where we were all real comfortable that the good insurance we had, our Medicare benefits, were gonna help us stay in that home, and they're certainly gonna help address those health issues, but the day-in day-out tasks of daily living, your health may determine that you just can't perform all those for yourself.
John
That's right. And so whether you're looking at in-home care that you're having to pay for out of pocket, whether you're looking at assisted living which also is not covered by Medicare and your other insurance so...

Lisa
Yeah. There's very little benefit or there's no insurance benefit for assisted living.

John
Right. So you're gonna be paying for that out of pocket, or nursing home care which Medicare will pay for the first 20 days of a nursing home stay and depending on your other insurance you might get up to another 80 days, but at a maximum you're looking at 100 days in a nursing home covered by insurance. After that, you're gonna private pay for that as well. And so, what you find out real fast is how much all of these things cost.

Lisa
So, we started talking about how health crisis oftentimes can lead to a housing crisis and now we're talking about well that all can lead to a financial crisis and how we're gonna pay for the type of care and the type of living situation we need and so where does that bring us to? 

John
Well, and so yeah, you've had this health crisis which has almost immediately really become a housing crisis, which has then almost immediately become a financial crisis. And that's where the kind of topics that we're gonna be talking about in this program really start coming into play is: How do you solve those financial crisis? What options are out there? How do you fix that? Because if you can maybe solve that financial crisis, well then that will solve the housing crisis. And if you've solve the housing crisis, we might not ever be able to make you better. If you have Alzheimer's disease, there's treatment but it's not ever gonna get better. It's a terminal condition. But, if we can solve the financial crisis, then we can solve the housing crisis, which is gonna allow us to manage...

Lisa
Manage and address.

John
Manage and address that health crisis as best as is possible under that particular individual situation. And notice I keep saying "that particular individual" because there really is no one person who's just alike compared to somebody else. We're not gonna be talking about things that are universal to everybody. What we are gonna do is take one more break and we'll be back in just a second.

John
Welcome back to Aging Insight. Before the break, we were talking about that oftentimes in our practice, we see where a person has had a health crisis, that the health crisis has then become a housing crisis, and then that housing crisis becomes a financial crisis. And that what we want people to do is be able to understand how they're going to manage through these things. And that's what this program's about, that's what our practice is about as elder law attorneys. And as elder law attorneys, we try to take all of these little pieces of the law, put 'em together so that we can manage that. And what we're gonna be doing here is passing that information on to you. And so, elder law is kind of a unique practice. You've gotta have your heart in the right place.

Lisa
I completely agree. Elder law is addressing the needs of seniors and the disabled and so often our seniors and disabled folks are just... They just don't seem to have as big of a voice and as much of their own direction. And so, my deal with being an elder law attorney and the reason I became an elder law attorney is I want to be that advocate for my seniors. And really, that's the way I look at it. That I certainly take 'em under my wing and it's important to me that they get to determine how they want to address their needs, live their life, on what terms, and I just want to equip them and give them solutions that are going to let them do that.

John
Well, and I'm the same way. We got into this elder law practice because we saw a need for a highly specialized area of the law that covers some very complicated situations. There's no doubt. Social Security is complicated, Medicare is complicated, Medicaid is complicated, Veterans Benefits is complicated. All of these things are complicated and that there just were not a lot of resources out there for people who are trying to have to navigate through all of these things, especially when they're already suffering with the side effects of aging. But the one thing I would point out, we talk about this as elder law, you do not have to be elder to need this information.


Lisa
Right. Well, and of course that's really why we're getting it out there is so whether you're 30 or 90, this is information that you need to put in your back pocket and you're gonna need.
John
Right. Traditional estate planning, going back... When I was in law school, for example, and they talked about... They had whole classes and I took every one they offered about wills and trusts and planning for this sort of thing. And all of the focus throughout all of these programs was on death. It was how to plan for death, it was what to do after death, how to manage things like death taxes, how to manage things like probate when you die, but it was always focused about death.

Lisa
And what is it that you say, John, when we talk to a lot of our clients when a lot of our clients come in and the first thing they wanna know about is, "Well, I need to get a will and tell me about these death taxes," and things like that? And we typically pull that client back from that focus and talk about, "Wait a minute. You're here, you're living, breathing. You've got a bunch of life to live so let's talk about what we can do to make that life the best we can." And so instead of estate planning, we talk about life planning.

John
Right. When I got out of law school and I started practising and I dealt with financial advisors and banks and different... I noticed that all of their focus was typically on leading up to retirement. It was save, put money back in your 401K, or your IRA, save some money, plan for your retirement. But it was always the focus was leading up to that 62-65-70 range and then it was like we just forget about everything from that point until death. And the focus completely switch, but you know the hard truth of the matter is, if you've spent every penny of your savings paying for your own care and gone broke in the process and become a burden on friends and family, and find yourself in a nursing home, what was there to will to anybody in the end? 

Lisa
Right. What was the estate plan about? And so we definitely... Estate plan is certainly a piece of what we do as elder law attorneys, but really the more important piece and where we like to bring that focus is to that life between retirement and death.

John
That's right. And so what we want you to do is also focus on that same sort of information by watching the show, hearing the information that we're providing, and seeing how it applies to your life because we're gonna be talking about things like how to pay for that long-term care, how to protect the assets that you have, how to qualify for benefits that might be available out there, how to get the most out of Social Security, how to get the most out of Medicare or Medicaid or the Veterans Administration, how to best document your wishes for who makes medical decisions for you, end-of-life decisions, all of these sort of things. And they're all little pieces to this puzzle, but as you see this program develop, and as you keep staying tuned and tune in week after week, what you're gonna start seeing is that these puzzle pieces will come together.

John
And you might even have questions. And as you do, you might try to reach us out there on the internet. We do have a Facebook page which is facebook.com/AgingInsight. There's a radio show which is a live call-in radio show, which is every Saturday at noon on 107.1. And so you could call in questions there. And frankly, what we might do is be asked... If we hear your question there, we might be able to answer it here. And so, the coordination of all of these things, hopefully we can get you that information.

Lisa
Right. And we have some printed materials for you, our Aging Insight magazine. You will see that out and about town, in doctors' offices, in financial advisors' offices. Again, it's just really about getting the information in your hands. John, I talked a moment ago about being an advocate and I wanna help my clients in just these community... My community members to be their own best advocate.

John
That's right. And you might be thinking, "Well, I'm not sure if any of this applies to me." But if it doesn't apply to you, it applies to somebody you know, maybe they're a friend, maybe they're a loved one, but it applies to somebody. And between the information we provide and what you absorb out there, we can make people's lives better, we can change people's lives, and we can keep people out of nursing homes, we can keep them from going broke, and we can keep them from being a burden on their family. So, stay tuned to the program.

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