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Caring for the Caregiver

Life as a Caregiver

Making Difficult Decisions continued...

For some families, the logistics of transporting an elderly parent -- especially during a busy work week -- can be a significant problem, says Kelly.

Every family needs some guidance in figuring it all out, she says. "That's where a case manager can help. It really helps to talk through these things with somebody who understands the range of options," Kelly tells WebMD.

Letting mom stay in her own home -- and managing her care long-distance -- may seem like a good option until you talk with a case manager. "If you're at a distance, you may have to travel more frequently to check in. That extra cost, along with the cost of care, can be significant over time."

Then again, the emotional component of relocation may defy all rational arguments, says Kelly. "Relocating may seem like the best option, but not what the older person wants to choose at that time. You can't discount the emotional aspect. Sometimes it takes a crisis to precipitate a decision."

Figuring Out Finances and Legal Issues

Legal and financial issues must be dealt with early, says Kelly. How do you pay for it all? Who will make decisions about the patient's care when incapacity strikes? Sorting through the legalities is a complicated issue, one that involves -- among other things -- setting up trusts to preserve assets, she tells WebMD. It also means assigning "durable power of attorney" status, which gives legal power to the adult caregiver.

These are difficult to discuss, especially when the family member is still fairly healthy. "People would rather talk about sex than money," Kelly tells WebMD. "It's very difficult to talk about the financial status of an older person while the person is still cognitively intact. But the earlier you can arrange those legal and financial affairs, the better.

"One of the most common myths is that Medicare will cover long-term care," she says. "It won't. Medicare is for acute, short-term hospitalization; it doesn't cover long-term care expenses."


By planning early, the family can make the best use of the person's assets, says Kelly. "Once the person becomes cognitively impaired, there are fewer options."

Long-term care insurance is another option -- one that Vivian discovered too late, she says. Such policies pay for a variety of nursing options, including day care, home care, nursing home care. But to qualify for these plans, the person must be in good shape mentally.

"We looked into it, but unfortunately mother didn't pass the verbal test on the phone," says Vivian. "She couldn't tell them her birth date, even though I was coaching her." While premiums on such policies are "pretty expensive, it would have helped with some of the anxiety about how we were going to deal with financing."

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