When the Folks Move In
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Multigenerational households are becoming more common -- and it's not just unemployed adult children moving in with baby boomer parents. Longer lifespans and rising health care costs are bringing more aging parents into their children's spare rooms.
According to the National Association of Professional Geriatric Care Managers, from 2000 to 2007, the number of parents living with their adult kids rose from 2.2 million to 3.6 million -- an increase of 64%.
When contemplating moving parents in with you, the impulse is often to welcome mom or dad with open arms and little thought of consequences. Experts on geriatric care suggest a more cautious approach. It's a life-changing step for the parent as well as the caregiving child, the household and the extended family, they say, and everyone needs to understand what's involved.
Will Your Parent Cross State Lines?
If moving parents in with you involves relocation to a different state, it's important to understand how this will affect insurance policies and health care.
Are there doctors where you live who are qualified to treat your parents' medical conditions? In some areas, it's difficult to find primary care physicians who accept Medicare patients, says Suzanne Modigliani, a certified, independent geriatric care manager based in Boston.
Is mom's supplemental insurance transferable? Some policies require establishing residency of at least six months, Modigliani says. What happens if she needs medical treatment before that? Who will pay for medical expenses not covered by Medicare or insurance?
Will You Assume a Caregiving Role?
Some long-term care insurance policies cover payment in certain situations to family members who are caregivers, says June Ann Schroeder, a Certified Financial Planner professional with Liberty Financial Group in Elm Grove, Wis., but the premiums are often prohibitive.
Medicaid may pay relatives for caregiving, too, in cases where the patient is eligible, Modigliani says. She recommends that the whole family agree to a care contract spelling out who will pay if the caregiver needs outside help.
Even if medical expenses are covered, hidden costs can add up quickly, says Schroeder, a former nurse who cared for her mother at home. For example, utility bills will likely rise. "Older people like it warm and need to turn the thermostat up," she says. "They may want their own phone line or account."
Special diets are almost certain to have an impact on the household food budget, Schroeder adds -- as are favorite treats, such as a cheese Danish with breakfast or a glass of brandy at bedtime.
"Caregivers may want to explore a financial contribution from the parent," says Miriam Zucker, a certified professional geriatric care manager and founder of Directions In Aging in New Rochelle, N.Y. "Not only because they may need it, but also because older adults need to feel that they are not a burden."
Get a Health Care Proxy, Power of Attorney
Be sure your parents' estate planning documents are up-to-date, says Delia Fernandez, a Certified Financial Planner professional at Fernandez Financial Advisory in Los Alamitos, Calif. "This is the stage of life when it's best to work with a specialist in elder care to be sure you have documents that will give you the power to act on your parent's or parents' behalf for health care decisions and finances if they are unable to do so," she says, "and also to determine whether or not they'd be eligible for Medicaid benefits."
Living with an adult child may change the parents' wishes for their estate, Fernandez says, and it's best if they can talk openly about it with the whole family. Otherwise, "When it comes time to settle the estate, the caregiver may feel entitled to a larger share than other siblings, and there could be legal issues."
Does Your Home Need Modification?
It's also important to estimate the cost of home improvements, Fernandez says -- "grab bars, accessible shower or bath or sinks, bedrooms and baths downstairs, and so on."
Unexpected space issues can cause havoc, says Schroeder. "The doorways may not be wide enough for her walker. He may be able to climb stairs now, but for how long? They may want to bring along some of the furniture they are used to, and that brings up other issues. What happens to the rest of their furniture? Should it be sold or stored? All these little things can really snowball, and the expense and stress pile up."
Ideally, Modigliani says, a semiseparate place such as a former home office with its own bathroom can be adapted, affording some privacy for everyone.
Are You Ready Emotionally?
"I always ask how the prospective caretakers get along with the parent and with their siblings," Fernandez says. If your relationship with your father has been strained, living under the same roof again is going to cause emotional stress.
Be sure the rest of the family is on board with your plans, Fernandez advises. "Caregivers can quickly feel overwhelmed by taking on the job of caring for aging parents, and coordinating with other family members is key."
If siblings are not willing to pitch in and give the caretaker a break now and then, Zucker asks, will they help pay for a companion to come in once or twice a week? "Adult children have to think about what sort of respite can be built into their home lives," she says, "so that they are not with their parents at all times."
They may also have to lower their expectations, Zucker says. Older people are set in their likes and dislikes as well as their ways, and this can cause conflict.
"The emotional expense is trying," Schroeder says. "You may become almost resentful of the parent living with you, and siblings may become resentful of you having mom's extra money, not understanding how much extra work there is."
If your parent has a new spouse, Modigliani says, his feelings on the move need to be clear.
Be Ready for Changes
Fernandez recommends consulting with a professional geriatric care manager to develop a plan of care. "You need experts to help guide you through the many resources available to the aged in your neighborhood," she says.
What is your parent going to do all day? Even if he doesn't need constant supervision, says Modigliani, "They are giving up their entire social network, and some thought needs to be given to what their lives will be like. Otherwise, they will be quite isolated."
"It's a tremendous change," Zucker says, "But if children and grandchildren are in the neighborhood, it can be a very meaningful time."