A Guide for Caregivers

Some 20 million boomers are caring for their families while trying to provide care for aging parents. Few know what they are getting into, says Donna Schempp, program director of the Family Caregiver Alliance, a San Francisco advocacy group. "Caregiving simply happens," says Schempp. "No one really chooses their caregiver. It's almost always a default decision based on who is available." Taking care of a parent can be tough. But there are some extraordinary resources available. The smartest approach is to plan ahead, recognizing that someday you will be a caregiver or someone will be caring for you. Here are some tips to help lighten the load.

Medical Issues
There will come a time when an adult child must make decisions regarding a parent's health care. To ease the way, there are two legal documents that experts say are vital. The first is a health-care proxy. This document, also called a health-care power of attorney, appoints a specific person to make all decisions regarding health care and end-of-life care, including refusal of treatment. The health-care proxy goes into effect when the attending physician determines that an individual is no longer able to make decisions on his or her own.

The second critical document is an advance directive, also known as a living will, which allows the person to state what kind of medical care he wants and which life-support procedures he doesn't want. "One of the greatest gifts an adult child can give to parents is to speak for them when they can't speak for themselves," says Kathy Brandt, vice president of the National Hospice and Palliative Care Organization. According to Brandt, advance directives can be powerful tools alone, but generally carry the most weight when combined with a health-care proxy. "It's kind of an insurance policy that your wishes will be carried out," she says.

It's very important for parents to talk about their spiritual beliefs and values, which may shape their decisions about the procedures they may or may not want at the end of life, says Brandt. One caveat: the laws governing advance directives vary from state to state, so it is important that they make sure their advance directives are state-specific.

Another type of advance directive is the Do Not Resuscitate order, or the DNR. Unlike the living will or health-care proxy documents, the patient does not prepare this document. The DNR is a request not to have cardiopulmonary resuscitation if the heart or breathing stops. Though it may be requested by a patient or by a health-care proxy, it is valid only if it is signed by a doctor. A DNR order will then be put into your medical chart. DNRs are accepted in all states.

Finances
Talking to parents about their finances can be extraordinarily difficult, but not talking about finances can be worse, especially if a parent's health starts to decline rapidly. In the past, estate planning involved little more than a will. Now, due to better medical care, people are living longer. That's why estate planning must cover long-term incapacity, including out-of-pocket expenses for assisted living, nursing homes (which, contrary to popular belief, Medicare does not cover long term), in-home care and other expenses related to aging. Long-term-care insurance is an option for some, but it is not a panacea, especially if people cannot keep up with rising premiums. Even if you are already a caregiver and your parents don't have an estate or financial plan in place, it is not too late. There are many strategies, such as reverse mortgages, living trusts and other options that may offer a solution to their long-term needs. A number of professionals can help form a plan, including attorneys, accountants, estate specialists and others.