Allocate Responsibilities for Planning Long Term Care
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It's tempting to think about a long-term care plan as all about Mom, or Grandma, or oneself. But in reality most plans affect others, either in their implementation or in the ultimate consequences. Be sure to think ahead and include these considerations in the plan.
When discussing how a long-term plan should be laid out, make sure to allocate responsibilities and to keep everyone informed. Knowing who can do what is imperative to making a long-term care plan work.
Making a list of responsibilities
As early as possible, perhaps after the first family meeting, ask each person in the core group to construct a list of what he or she would be able to do to implement the proposed plan. The tasks can be time limited, such as helping you or a parent to clean out a house, sell or donate unwanted items, and plan a move.
It could be long-term, such as providing primary care one day a week, one weekend a month, or some other period. It could be monetary, including offering to pay for home modifications, some home care assistance, or a designated amount for the overall budget. Or it could be an offer to have your parent move in with you or to move in with your parent.
When you have everyone's lists, compare them and see if tasks are self-allocated in a generally fair and workable way. The goal is not to arrive at an exactly equal division of labor or financial contributions; this is not like dividing a pizza pie.
Rather the goal is a fair distribution of participation, one that takes into account the different participants’ other responsibilities, assets, location, and other factors.
It is possible, and maybe even likely, that the preliminary allocation of tasks doesn't work for some reason — everyone wants the same job, for example, and some jobs are not spoken for. In that case, time limits may be helpful — If you do the transportation this month, I'll do it next month, and we can work out a schedule after that.
Or some jobs may require paid help. Better to spend some money to hire someone, if you can afford to, than to leave the job undone or done by an unwilling person. And in some families there are people who just won't do anything; they may give a reason or they may not. Perhaps a private conversation with this person to try to understand what is going on — which may not have anything to do with the issue at hand — will result in some cooperation.
Of course, as time goes on and needs change, the agreement may have to be revisited. But if the concept of sharing is well embedded in the arrangement, changes are more likely to be negotiable. Sharing is a concept we are taught as children; it is just as important in long-term care.
Taking on financial responsibility
Whoever has the responsibility of dealing with financial affairs should understand the seriousness of this task. It is more than paying monthly bills and balancing a checkbook. It involves keeping detailed records of how your or your parent's money is being spent.
This may seem unnecessary in families with good relationships, but it is prudent in every case. Working with an accountant or another financial advisor, if feasible, set up a way to record income and outlays. Major financial decisions, like taking out a reverse mortgage or buying an annuity, should be discussed with the core family group.
You or your parent should have an up-to-date will, and its provisions should be shared with the core group. The names of the person who is designated as healthcare proxy and the alternate should also be shared.
Being the medical record keeper
If one person is designated to accompany you or your parent to the doctor and to monitor health conditions, that person should also share important information with the core group. If possible, you should ask permission from your parent or other relative to share this information with specific people.
Without this ongoing medical information, others will not understand the severity of an illness or a cognitive decline. Many family disagreements about end-of-life decisions start from inadequate information much earlier in the course of the illness. Partly this problem comes from some doctors’ unwillingness to give bad news, but the person closest to the situation may also be reluctant to accept or share this bad news.
Timely sharing of medical information can also inform discussions of palliative care and hospice and make it more likely that these options are instituted early enough to make a real difference in care.