Senior Care & Planning for the Future

As we round the corner into the elder years, we must consider what would happen in case we suddenly needed home care or assisted living

We are all guilty of not addressing the future until it happens.  Planning for late-life scenarios can be complex but failure to plan can result in confusion and rushed decisions based on unclear expectations.  It can cause significant disruption to a family and be a costly mistake.  There are several things we can do now to ease future burdens and protect all we’ve worked for. Preparing now will allow us to focus on getting the care we need when the time comes.  It’s never too early to create a well-thought-out plan that can protect you and your assets should you need future care. 

Create Legal Documents that Protect You.

  • Power-of-Attorney: A POA is a legal document that allows you to appoint third parties to act as your representative. Most POA’s authorize a representative(s) to make specific types of decisions about financial, medical, real estate, vehicle sale, etc. on their behalf.  POA’s are limited in duration.  A POA must contain the full contact information of both you and your representative(s), the date signed, the powers you have given to your representative(s).  A Notary must be present to witness the signatures.  There are three kinds of Powers-of-Attorney:
    • General POA - A general document expires the moment you become incapacitated. A durable document continues until you die.
    • Durable POA – This document authority continues until you die. You must also stipulate if a Durable Power-of-Attorney covers financial/property affairs or health/welfare or both.
    • Limited POA - A limited POA specifics exactly what powers the representative(s) has and for how long. You can end or change the Power-of-Attorney at any point. It does not need to be recorded in the State of Kentucky unless it’s used to convey, release or transfer an interest in real estate.  You may want to check with your local County Clerk to see what the rules are in your state.
  • Will: Be sure to up-date an existing will to include who, what and how.
    • Who will be in your Will, such as: beneficiaries, guardians, or a favorite charity?
    • What will you do with all of your property, both physical and virtual?
    • How will issues like childcare, health care and pet care be handled?

You may write a will yourself if you are over18 and of sound mind but it must be in your own handwriting.  After your death, someone close to you must testify that it is, indeed, your own handwriting.  If your will is typed, it must be signed by two witnesses.  Even though you can prepare a simple Will yourself, it may benefit you to have the assistance of an Elder Law Professional for complicated Wills.

Without a Will, Courts will appoint someone to deal with your stuff who probably won’t know what you wanted.  A Will must be filed with the Court regardless of whether the estate goes through probate.  The Court must prove the validity of the will and settle any disputes if someone contests the will.

  • Trust: A Trust’s primary purpose is to avoid probate proceedings. It is drafted and funded according to your wishes. Like a Will, it expresses how you wish your assets to be used.  There are several types of Trusts and should be done with the guidance of an experienced Elder Law Professional. 
  • Living Will - A Living Will is an advance directive that allows you to determine the scope of medical treatment that you want if you become ill, and most importantly, if you are disabled. A Living Willrestricts a patient’s right to food, water, and assisted breathing in a terminally ill state.  With a Living Will, you can appoint a trusted loved one to make these difficult medical decisions on your behalf that follow your wishes.  These documents must be notarized so it’s important to give your family direction ahead of a family crisis.  It’s an emotional, time-consuming process to file in Court for this permission during an emergency situation. 
  • Medical Order for Scope of Treatment (MOST) – This form supplements a Living Will, Advance Directive or Durable POA and must not be in conflict with them. In case of an emergency, the MOST form is printed on pink paper, signed by yourself or healthcare surrogate and your doctor. It is made available to all medical professionals to ensure your wishes are honored.  We all shape our lives by the choices we make and how we care for ourselves.  When it comes to end-of-life medical care, we can use MOST to have a voice in that also.  As difficult as the subject may be, it is even more difficult for your loved ones to be confronted with these decisions in an emergency.  MOST keeps loved ones from having to make those difficult decisions for us.
  • Do Not Resuscitate Order - A DNR is an advance directive to not resuscitate a patient who has stopped breathing or whose heart has stopped beating. It is important to know that only the “original” DNR can be accepted by EMS. Copies are not accepted.  It is best to have several “original” copies of the DNR available so all parties have an actionable form.  You can (for KY) print this document  Please note the DNR must be assigned according to your state’s guidelines.  A DNR is not the same as a Living Will.  (The American Heart Association in 2005 moved from the traditional do not resuscitate (DNR) terminology to do not attempt resuscitation (DNAR). DNAR reduces the implication that resuscitation is likely and creates a better emotional environment to explain what the order means.)

To revoke a DNR, speak with your doctor. In addition, you should destroy any documentation that asserts the DNR, including bracelets, wallet cards, or other indicators that might be found by emergency personnel.

  • Advanced Funeral Directive: If you don’t make any preferences legally known, then the decision falls to the next-of-kin (nearest relative). If the next of kin is unavailable or unable to make decisions of this nature, the next of kin hierarchy is followed until someone who is able to make these decisions can be found. It’s better to discuss the funeral with your family now and explore all your options.

The Funeral Consumers Alliance says if you don’t know where to begin, start here:

  • Figure out how much you can afford.If you haven't looked at your budget with your family, stop now and do that before you go any further. The cost of the funeral has nothing to do with how much you love and respect the deceased. Read our article: How to Choose a Funeral Home
  • Set a solid budget.If you don't set a limit on how much you can comfortably spend, the funeral home won't either. Setting a sound budget means figuring out how much you can afford without skipping out on your rent, depleting your savings, or taking on high-interest credit card debt. Read our article: Ten Tips for Saving Funeral $$
  • Make sure you shop around.Funeral prices vary by thousands of dollars, for exactly the same service, all within the same town. Don't simply go to the last funeral home you used without comparing them to the competition. Check to see if there's an FCA near you; our groups do helpful cost-comparisons. Next Steps: Find a Local FCA Near You.
  • Establish a Caregiver Agreement. The elderly can thrive in the comforts of home with a support system of professional and/or family caregivers. They can provide you with companionship, personal care, housekeeping, transportation, meals and other things to ease your way.  Or, you may feel more comfortable in assisted living where you have the companionship of other seniors and caregivers on call.  Whichever way you choose, establish a caregiver agreement.  Have a formal contract even if you don’t exchange any cash payments for now.  Put your wishes in writing, even if the caregivers are your children.  Set the payment amount and include terms that are important to you.  This can save you a lot of money and hassle in the long-run.  
  • Prepare for Change. Data from the CDC suggests that every senior citizen is at great risk of fall.

“One out of five falls will result in serious injury such as broken bones or a head injury.  Each year, 3 million older people are treated in emergency rooms for fall injuries.  Over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.  More than 95% of hip fractures are caused by falling, usually by falling sideways.  Falls are the most common cause of traumatic brain injuries (TBI).  In 2015, the total medical costs for falls totaled more than $50 billion.  Medicare and Medicaid shouldered 75% of these costs.”

Once an older person falls, it doubles the chances of falling again.  In addition, dementia and other new conditions can develop any time that require changing your environment quickly. Change is certain eventually.  It’s best to be prepared by having plans in place that protects your assets if Medicaid comes into the picture later.  If you already have caregiving in place and plan to go into assisted living, you may want to consider a free transfer of your house to your child. 

  • Explore Every Possible Benefit Available to You. VA may provide benefits for nursing home, assisted living or homecare, in addition to pension benefits, medication or funeral benefits. Medicaid will pay for in-home care, in one form or another, in all 50 states. Traditionally, Medicaid pays for nursing home care for persons who demonstrate a functional and financial need. Explore Medicaid and other insurance options, along with every other possible benefit available to you.  You may not be aware of what assistance is available so ask questions.
  • Investigate In-Home Options. By utilizing benefits that allow you to stay in your home, you may choose not to go into assisted living. The Home and Community-Based Waiver program through Medicaid may be the option that keeps you living at home and still get the care you need.  Considering the high costs of senior living and long-term care, care at home may be the less expensive options.  You can get free assessments for care and costs.  Home caregiving has the additional benefits of scheduling caregivers when you need them most and may be augmented by medical home health services when appropriate.
  • You don’t have to do this alone. Be prepared to speak frankly and truthfully about your desires and assets. A child, close friend or Elder Care Professional can help you get together paperwork and explore your options. Staying happy and healthy into your elder years is a journey we can do together. 

Author:  Judy Harrison enjoys writing, public relations and supporting small businesses.  After years of family caregiving, she has insight from both the caregiver and patient perspectives into the journey of elder care.  She believes we have a lot of work to do in order to support our elderly in a healthy, compassionate way but we are making progress.  Most elderly prefer to remain in their homes so she actively supports building a care team of home care providers to support their needs.  Contact her at This email address is being protected from spambots. You need JavaScript enabled to view it.    

*Disclaimer:  This article is for information purposes only.  It is not intended to substitute for personal, legal or medical advice.