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Planning ahead can help families cope with Alzheimer's



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DALLAS - Sharon McIver spends a good part of her days stretching her 86-year-old mother's dollars as far as she can. In the morning, the Dallas woman looks for sales on personal items her mother needs. After lunch, she makes a call to dispute an unusually large medical bill. And by evening, she has searched for the highest interest rate for her mother's bank certificates.

"I feel as though I'm running two households," she explains. "It overwhelms me some days."

That's a common feeling among people who care for parents with Alzheimer's disease. Adult children like McIver shoulder many tasks as caregivers, but overseeing their parents' finances can be among the most difficult.

The bills are staggering - they average $25,000 annually for home care and $50,000 per year for nursing homes. And financial resources often are limited - Medicare doesn't pay for long-term care.

Alzheimer's patients with retirement nest eggs can exhaust their savings within several years.

After having her mother live with her, McIver moved her to an assisted-living center this spring.

"I just couldn't keep her with me anymore," she says. "Her dementia had become too severe."

McIver's mother pays for her $118-a-day room with her savings and Social Security check. Yet as hard as McIver tries to stretch those dollars, she expects her mother to run out of money within three years.

"After that," the daughter predicts, "her only option will be to go on Medicaid."

Managing the money of aging parents is always a big responsibility, but it's especially true of Alzheimer's patients. Sons and daughters can't talk finances with parents whose mental faculties have dimmed. A person with Alzheimer's lives an average of eight years and sometimes as long as 20 after the onset of symptoms.

Geriatric care manager Kay Paggi of Richardson, Texas, has found that families often don't understand the financial implications when a parent is diagnosed with Alzheimer's.

"Every week I hear from sons or daughters who think Medicare will cover their parents' long-term care," she says. "It's up to me to tell them the bad news - Medicare will cover hospital stays but not extended care."

Long-term care insurance can help cover the costs - if you've already got a policy.

"Trying to buy a long-term care policy after you've been diagnosed is like shopping for homeowners insurance the day after your house has burned down," Paggi says. "You aren't going to get one. The time to purchase a policy is before serious health problems develop."

Financial advisers agree that families who think early about how to pay for an aging parent's care will have more options.

"Money can be a touchy subject in any family - children are afraid to pry, and parents value their privacy," says Kevin Pittman of American Express Financial Advisers in Addison, Texas. "Still, I can't emphasize enough the importance of coming up with a financial plan as early as possible."

Here are some points that experts say adult children should cover when they sit down with Mom or Dad to talk about their financial future and Alzheimer's care.

Be tactful.

Virginia Morris, author of "How to Care for Aging Parents," advises treading gently when you raise the issue of managing your parent's money.

"Letting someone else take charge of your finances is a clear indication you're losing control of your life," she says. "It can be demeaning and hurt your self-esteem. Children must be mindful of that and always act respectfully."

Morris recommends gathering the family - including all the adult siblings - and posing the question of money in terms of how the children can provide the best possible care for the aging parent.

"Say, `Here are the things we want to discuss with you today to make sure we can take good care of you in the years ahead.'"

Put one person in charge.

Elder law attorney Janet Boyanton of DeSoto, Texas, says your parent should execute a document known as a durable power of attorney, which gives an individual of your parent's choosing the legal authority to act on his or her behalf until death. An attorney can help with the paperwork.

Boyanton advises against delay. If your parent becomes mentally incapacitated, you may need to go through the cumbersome process of gaining legal guardianship to manage financial affairs.

Gather important documents and study them.

Paggi says providing for your parent's care requires having a full understanding of the financial assets and liabilities.

That includes checking and savings accounts, Social Security income, certificates of deposit, stocks and bonds, real estate deeds, insurance policies and annuities, pension benefits, credit card debts, home mortgages and loans, and so forth. And don't forget your parent's legal documents, including wills and living wills.

Ask some basic questions. And consider consulting professionals.

What are your parent's current financial needs and potential needs?

Morris says most families try to keep a parent with Alzheimer's at home as long as possible, hiring home care aides to help. But for many, a nursing home eventually becomes necessary.

Is your parent able to pay for that care?

Calling on a financial adviser or geriatric care manager may help in answering those questions and identifying community resources to defray the expenses.

Think long and hard before cracking into your own nest egg.

Paggi says she often has clients who spend their own retirement nest eggs on their parents' care. "There's no right or wrong choice - everyone needs to make the decision that works best for him," she says.

Carefully evaluate nursing home options.

Experts say it's never too soon to start looking at nursing homes.

"Some have waiting lists, and you may need one for your parent before you think you do," Morris says. "And because Medicaid patients tend to have fewer choices, it's better to apply before your parent has exhausted his savings and your family still can pay."

Know Medicaid's requirements.

Families should become familiar with Medicaid's limits on the income and assets someone can have and still qualify for assistance, Boyanton says.

In Texas, you may have no more than $1,692 in monthly income and $2,000 in assets - excluding your house, car and a few other personal belongings. The law makes allowances for spouses so that a wife's or husband's nursing home costs don't impoverish them. A spouse at home may keep - in addition to the house, a car and other personal belongings - half of the couple's assets, but no more than $92,760 and no less than $18,552.

Think about long-term care insurance for yourself.

Pittman says it may be too late to buy long-term coverage for a parent already diagnosed with Alzheimer's, but it's not too late for you.

The earlier you purchase such insurance, the lower the premiums will be (and the longer you'll pay them, of course). He says a policy will help guarantee good care for yourself, if you ever need it, and give your children some peace of mind.

Be a model child.

Finally, financial planners point out that how well you look after your parents' finances today is likely to be the model for how well your children will treat you when your turn comes.

As Morris says, "Instead of titling my book `How to Care for Aging Parents,' maybe I should have called it: Be Nice, You're Next!''

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(c) 2004, The Dallas Morning News. Distributed by Knight Ridder/Tribune News Service.

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