Reprinted from the Health District's quarterly publication mailed to district residents (Winter 2008)

Sharon Greenlee is thankful that she and her husband, Richard, talked about “what if” long before they had to.

“It was a shock when Richard was diagnosed with leukemia,” Sharon says of her husband of 35 years. “But thankfully we had all the documents and plans in place so we didn’t have to make the decisions about his care at such a stressful time.”

When Richard died this fall at age 75, Sharon, who lives in Fort Collins, found peace in the fact that the end of his life was lived according to his wishes.

“I urge everyone I know to talk to their loved ones about what their needs and wishes are for their care when they can no longer care for themselves,” she says. “It’s one of the most important conversations you will have as a family.”

Planning for the care of an elderly family member involves anticipating both short-term scenarios like the Greenlees experienced and the possible need for long-term care. Because a spouse often isn’t able to provide care, the responsibility often falls to the children or other close relatives.

“This isn’t something that’s easy for anyone to bring up,” says Nancy McCambridge Driskill, owner of Consultants for Aging Families, a private geriatric-care firm. “Your roles are changing — now a child is looking at being the one to take care of a parent, and that’s uncomfortable for most.”

Although uncomfortable, it is crucial that family members ask their elderly loved ones what their wishes are.

“It’s incredibly important to include the parent in the process for all the reasons you might imagine,” says Lynette McGowan of the Larimer County Office on Aging. “If the older adult is not a part of the conversation, if they aren’t listened to and given a voice in what is suitable for them, the plan just isn’t going to work.”

It’s important that as many family members as possible attend the meeting to discuss plans for elder care.

“If everyone isn’t there, you might end up having one family member say, ‘I think Mom would have wanted something different,’” says Ellen Pihlstrom, a senior resource specialist with the Aspen Club, a senior services arm of Poudre Valley Health System in Fort Collins. “There’s no question what Mom would have wanted if you were all at the meeting and you all heard what Mom wanted.”

Making a plan starts with an assessment of the individual, including what documents and plans they already have in place.

Legal documents

One of the first steps in planning for the care of an elderly loved one should be setting up a medical power of attorney.

“Your loved ones would hate to guess what you would have wanted, and doctors don’t want to be put in that position either — so the best thing to do is get it in writing,” advises Pihlstrom.

When the Greenlees drew up their medical
power of attorney, they designated each other to make decisions, and each named one of their children in the case that their spouse wasn’t available.

“Of course you can’t anticipate every possible scenario, so it’s important to talk about those issues until they know your heart and what your true wishes would be,” Greenlee says.

It’s also important to set up a durable power of attorney for all other nonmedical decisions. Help with drawing up this document is available through the National Elder Law Foundation
(see sidebar).

Insurance issues

Although seniors are barraged by offers from private insurance companies, they are advised to seek insurance advice from a neutral public entity such as the Aspen Club.

“We’re not here to sell any specific type of insurance,” Pihlstrom says. “We look at your income limitations and health limitations and then make suggestions based on what’s available.”

One new option for those with Medicare is to enroll in a Medicare Advantage Plan, which covers gaps in Medicare A and B coverage such as co-payments and deductibles.

“Medicare Advantage can be a good option for people who are looking for more complete coverage,” Pihlstrom says. “But there are also drawbacks, such as not all physicians accepting this insurance. We can help you weigh those differences.”

Housing options

“There’s a lot of marketing going on for assisted-living and retirement communities, touting it to be the most wonderful answer for everyone,” Driskill says. “But people are more complicated than that; they have idiosyncrasies and needs that aren’t that obvious. You have to investigate options and find the one that’s the best match.”

Independent-living facilities offer seniors a community lifestyle with benefits including some meals and planned recreation activities. Assisted-living residences are designed for individuals who require help with activities of daily living but do not need the skilled medical care provided in a nursing facility. Nursing facilities provide 24-hour care. Some communities have specialized units for individuals with Alzheimer’s disease and other forms of dementia.

Those seniors wanting to stay in their own home as long as possible can utilize a wide variety of in-home care options, including companion services, home healthcare, housekeeping services, errand-running services and meal preparation or delivery.

Care for the caregivers

There’s one piece of the elder care plan that is often overlooked: taking care of the caregiver.

“What we see in the U.S. is about 80 percent of the long-term care being provided by family caregivers,” says Christine Fruhauf, an assistant professor in
Colorado State University’s Department of Human Development and Family Studies. “Over time the caregivers find themselves physically and mentally worse off than the recipient.”

Fruhauf urges caregivers to take care of themselves so that they will be able to continue caring for their elderly loved one. “If you have the resources, get some assistance with grocery shopping or picking up the meds,” Fruhauf says. “You don’t have to give all of yourself all of the time.”