Looking for a slightly less controversial topic than President Donald Trump for a family holiday gathering? If so, ask the following question at the dinner table: How are we going to take care of mom and dad as they age and need help?
The final assignment for my Introduction to Health Policy class at Duke University this fall had students write a letter to their parents telling them how they and their siblings planned to see to the three types of help that most people will need if they live long enough: first, help navigating basic life tasks such as paying bills, filing insurance claims, maintaining a household and driving; second, providing direct help to do things like dressing, bathing and using the toilet; finally, ensuring they have a stable housing situation.
Families have cared for one another for millennia, but the retirement of the baby boomers will strain not only the budgets of public insurance programs like Medicare and Medicaid, but the resources of the (fewer) children that boomers had. Adult children face a basic choice when their parents need help: pay for it with your own money, money that might be yours someday, or pay with your time.
There are benefits to families caring for one another, but most underestimate the costs (dollars, time and strain). And since your mother only dies once, there is a learning problem inherent in caring for an elderly parent —- once they die, there are not typically effective ways to pass on the hard-earned wisdom to those just beginning the journey. As a result, most people are woefully unprepared to face a completely predictable phenomenon.
To help my students develop their plans, I provided these prompts.
• What is a realistic lifespan for your parents?
• When will they likely need help? Today, three months, three years or 10 years in the future?
• What warning signs should you look for that your parents need help? Falls, driving problems, loss of ability to do things they have been good at like cooking a meal, saying they overwhelmed by everyday life, losing things and expressions of concern from friends or a physician.
• Do you know the difference between Medicare and Medicaid?
• Will they have retiree supplemental insurance? Should they purchase a Medigap plan? Medicare Advantage? Private long-term care insurance?
• What assets and income streams will they have in retirement?
• If their housing situation is unstable/safe, will they move in with you? Elsewhere?
• How do you pick a nursing home for your mom?
• How will the family divide the tasks (planning, paying, caring, hosting)?
• Has your parent expressed preferences? Are they realistic, financially and otherwise?
• Are their legal affairs in order: will, living will, durable power of attorney, advance directive, plans for burial/cremation?
Communicating about these issues will be hard and take practice. My marriage was strengthened by caring for my mother-in-law with my wife, but the strain of family caregiving tears apart some families.
The lack of a coherent means of helping the elderly navigate their need for help as they age is the most important societal issue facing our nation that is not commonly discussed. Answering these questions will affect far more persons than will the fate of the Obamacare exchanges, for example.
If you are my age (51), then you not only should be thinking about caring for your parents, but also about how to make it easier for your children to care for you. This is one issue that is not like fine wine — it does not get better with age.
Donald H. Taylor, Jr. is a professor of health policy at Duke University's Sanford School of Public Policy. He is writing a book titled "How To Care For Your Parents Without Killing Yourself."