The Brutal Math of Caring for Aging Parents, with MarketWatch Columnist Beth Pinsker

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30:15Let's move to the second phase of this progression. So previously we talked about what to do if you have an elderly parent who might need some physical help. Right. But who cognitively is in excellent condition. Now let's move to what you should do if you have an aging parent or grandparent who is in some level of cognitive decline. Yeah, those I mean, my case was really fast. Those situations, because nothing's wrong with the body, they can last 10 years, 12 years. You really have to do some financial planning for those circumstances because it could be a long time. Your case was passed, meaning your mother's declined.

31:00My mother's declined. Yeah. My dad was sick for about four years, but my mom was his primary caretaker. My mom was sick for eight or nine months. The costs of that were not the same as if she had lived for 10 more years. There are very few fortunes in the world that can sustain dementia illness for 10 years. I talked to one woman for my book, and her mother lasted, I think she was in memory care for 12 years altogether, and she outlasted her money by a month and a day. So this costs like$12 ,000,$15 ,000 a month. She had a pretty good nest egg to begin with, but the years grind by and grind by and grind by and then the person is still alive and needs to be taken care of with the same degree of love and everything that they had at the beginning.

31:51But the money's gone. Everybody needs to think about what that means for their family because everybody has a different level of wealth and has a different standard of living, different thoughts about quality of living, different thoughts about end-of-life care and what they want in terms of heroic measures. These are things that are very personal and that you have to talk through. But in terms of the legal documents, you'd be surprised how many legal documents you can get signed with somebody who is in cognitive decline. That's terrifying. It's a little terrifying. I went through all this paperwork when I inherited all these boxes, and I found a power of attorney that my grandfather had signed in the nursing home when they put him in with dementia.

32:40How did this happen? How did anybody allow my grandfather to sign this document? And apparently I talked to some lawyers, and there is a very different standard for being able to sign that form. And people have good days and they have bad days. And so just because somebody is diagnosed with Alzheimer's or another cognitive issue does not mean that it's game over, that you can't get that document signed. There are lawyers who will go to nursing homes, they will assess the situation, and they will get documents signed when they can get them signed. Because the alternative is so onerous that there's some leeway, but that window shuts.

33:18So if you can sneak in under the window, do it fast. Get that done. So the first lesson is get those documents, those powers of attorney done as soon as you can. The sooner the better, while everybody's good and fine, you want to do it. But then once you're into a cognitive illness, you really got to plan for a long time. You never know what's going to happen. Routinely, it's 7 to 10 to 12 years. It's hard. Like you are on task for all of that. And it wears people out. It's a very hard thing to do, but you have to. The advice I got from people who have lived through this is pace yourself, do what you can, make sure you take care of yourself.

34:06And there are social safety nets in the US. They're very difficult to use and they're always in jeopardy. Now, maybe more so than ever. But when you do run out of money, when your parent is literally at almost a zero balance, there are safety nets that will pay for care. There are some safety nets that will pay for you to care for them if you're qualified or for them to go into a caregiving facility. There are a lot of requirements to me and there's a lot of red tape, but we do still have social safety nets in the U.S. Those are state-by-state specific, right? They are all state-by-state specific.

34:48So the amount of money and the qualifications for being an at-home caregiver are different in every state and more generous in some, like New York is particularly generous. Level of income you're allowed to have and the level of assets you're allowed to keep hold of is different in every state. But it's still really low no matter where you go. The federal limit is set somewhere around$2 ,000. So you have to wait till a parent gets down to their last pennies, basically, before you can put them on Medicaid and get the facility covered by Medicaid. And then, of course, you face all the practical hoops and obstacles that you have to jump through.

35:29You can't just put your parent in any facility and get Medicaid to pay for it. That facility has to accept Medicaid. And many of the good ones do not. My grandmother, for instance, was in a facility, an assisted living facility. She lived there for 12 years and she went through the various levels. So she started out as independent and then she moved up to the nursing care unit. And then she ran out of money. And they took Medicaid for those nursing care beds. And she was able to talk herself into one of those Medicaid beds. And she lived there for the rest of her life with Medicaid paying for it.

36:06I called that facility to see what that costs these days, and they don't take Medicaid anymore. They don't have any association with Medicaid. So my grandmother could not have aged in place in that facility if she were still living today. Think about that. What would happen if you had your parent in a facility and they ran out of money and they didn't take Medicaid? What would you have to do? Well, you have to move them. And I have a friend. She was in this exact situation. Her mother was in a facility. She and her husband were helping pay for it. The mother ran out of money, so they took over the full payment of it.

36:42It's like$12 ,000 a month. Then she got divorced, and her ex-husband no longer wanted to pay for his ex-mother-in-law to be in this facility for$12 ,000 a month. And she said, I can't afford it on my own, so I need my mom to go on Medicaid. But the facility didn't take it, so then that meant moving her mother. So now she's going through a divorce and having to move her mother and still having to figure out some way to pay for it because most of the facilities that you deal with require you to pay for several years before you can put them on Medicaid. So they require two to four years of full pay before you can then switch over to Medicaid, even if you're eligible.

37:23And these are what you would call, you know, the good ones, right? Like these are the facilities you want your parent to be in. And so she went looking for a facility that would accommodate her mother. She called one of those services that you can call, and she got a referral. It was far away. And she's sitting at a bagel shop complaining about this situation and being in misery about it to a friend of hers. And somebody leans over from another table and says, those places that give you referrals only give referrals from the places that pay them to give referrals. But there's this other place right down the road and they don't go with that agency, but they're really good.

38:04My mom is there. You should check it out. And she went to check out the facility and she liked it. And that's where her mom ended up. And it strikes me how much that whole story hinges on chance, random chance. It also hinges on the fact that you could be in any bagel shop in anywhere in America and somebody else at the next table is going through this too. And we all have to share information with each other. you can't be afraid to talk about this stuff because somebody might have a piece of information that you could use or they have gone through it and they have a trick that could help you.

38:36Which also kind of speaks to how much information asymmetry exists in this arena. Yeah, there is nothing out there that covers every situation. Everybody's a little bit different. Everybody's in a different place. It's maddening. We need to up the education and up the information level on all of this, because we're all going to be dealing with this, either for somebody we love or for ourselves. Like, we're all going to get old, too. And I think the people who have read my book so far have told me that this really opens their eyes to what they need to do for themselves, too. And it certainly did for me.

39:12Dealing with all my mom's stuff, like, really made me see that I was putting some obstacles in place that my kids would have to jump over if something should happen to me. And I've been doing my best slowly to like, clean all that mess up. I want to die and then have my kids be able to be just like, we loved you. Everything's good. And I leave no mess behind. I want to leave no problems behind. I want to go out clean and not have anybody have to deal with my stuff and whether they can part with a clip of an article I wrote in 1993 that I'm still holding on to, they'll just be able to press a button and say goodbye.

39:56But then my significant other keeps buying things. And I'm like, well, what are the kids going to do with this after we go? They'll have China to dispose of at some point. Can we walk through the various care options? You mentioned assisted living, but I want to walk through the menu of choices because there's in-home care. Yeah. There's, what's it called? Continuing care communities. Yes. Yeah, yeah. That's the one. Yeah. CCRCs. CCRCs. That's it. Right. Those are what I call the condo model. There's the rental model and the condo model. The rental model is like your assisted living where you like rent an apartment, you pay a monthly fee and you get to live there.

40:42And they usually have several levels of care that go up that you ratchet up as you need it. The catch with those places is usually there's like a monthly base fee and then you have to upsell. They upcharge for all the ancillary services. So in the CCRC, it's like you buy a condo and then you pay a monthly maintenance fee. And on top of that, sometimes they upsell for other charges. You want a cleaning lady to come in once a week. You want physical therapy. You want meals delivered to your room instead of the dining hall. There's upsells for all of those kinds of things. And then you get to your pure nursing care situations.

41:22Then you get to facilities that are only private pay, where you have to pay the full cost of the facility. And depending on where you live in the country, it could be anywhere from$4 ,000 or$5 ,000 a month to$20 ,000 a month. Then you have facilities that are mixed. Some residents are private pay. Some residents are getting paid through Medicaid. And then you have Medicaid-only facilities. Those are typically less bells and whistles because the Medicaid rate of reimbursement is much lower than the private pay. The government is not paying the Medicaid nursing homes$12 ,000 per resident per month.

42:03And so just by fact of that, you're getting less in those places. The staffing is less. The food is of a lesser elegance kind of thing. You can't order a grilled cheese on demand in a lot of those places. If you've ever had a parent who is sick in any way and they have to go to rehab after a hospital stay, you will be given a list at the hospital of places in your geographic area that will take a Medicare patient for a short-term stay. And Medicare will only pay for this short-term rehab. A lot of people are under the impression that Medicare will pay for the nursing home. No. I have a sidebar in my book of answers you don't want to hear about Medicare.

42:52The number one is Medicare pays for long-term care. No, it doesn't. Medicaid pays for long-term care, but you have to qualify. And Medicare will pay for a short-term stay after a serious illness. But this is where most people encounter these choices. You get this list and then if you're diligent about it, you go around and you visit all the different places. I did this both for my mom and my dad when they were in the rehab phase of things. it's immediately clear when you step over the threshold of any of these places what the payment structure is like you can literally smell it we call it the smell test like you have to go to these places and you have to walk in the front door and you have to see what's going on and you have to smell what's going on you will know the difference viscerally immediately and you will say I don't want mom or dad in that place.

43:51And you will cross that place off the list. And I'm not saying that all Medicaid places are bad because you can walk into one and it can be great, but there's more money in the other places. And so when there's stuff money can pay for, and staff is one of them, and staff cleans stuff and buys new furniture and pays attention to the lighting and those sorts of things. You really have to go boots on the ground for that sort of thing. You cannot go by a star rating from the Medicare system. You can't go by what somebody says. You really got to go. You got to see how many patients are lined up in wheelchairs around the nurse's station.

44:37You got to see what the dining hall looks like and what the people look like who were sitting there. You got to hang out there for a while. Yeah. Like I went to one nursing home. I remember they were bringing the patients in for lunch at 1030 because they didn't have enough staff to bring people sooner. And so the staff would go and bring one person in and they'd go and bring another person in. And then the residents just sat there at their long tables for like two hours, waiting for lunch service. And they would be brought in one by one as staff was available and they were just sitting there waiting for lunch to happen.

45:18And then the same thing happened after lunch was served. They were all slowly shuffled back to their rooms. That was sad. I didn't like that place. But you can't know something like that unless you go and visit. And when you're going to put your parent in a place and you're not going to be there every day, you need to know what's going on. You really need to see that. Make sure it's what everybody's on board for.

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48:19let's move to what a person should do if a parent a grandparent somebody that they're caring for passes away what do you need to know as a financial caregiver well the first thing is is that you can take a minute for yourself i got covid at my mom's funeral i was like completely incapacitated. And it was the first time I had gotten COVID too. I wanted to do things and I would have done things. And COVID prevented me from doing things. And that was probably the best thing that could have happened to me. I needed a minute. And this is why I say the power of attorney is almost more important than any of these post-death documents, like a will and a trust.

49:05Everybody says will, it's Kleenex. Like it's a brand name. Like you die, you need a will. But I think power of attorney is more important because when somebody is alive, there are deadlines. When somebody dies, you have a minute. Nothing's going to happen the next second. And so you can take a deep breath and you can mourn the person. the most important thing I did and I learned this from a financial planner I interviewed years ago forward the mail like do one thing forward the person's mail to yourself if you're the one responsible anything that happens or that you need will come to you and as long as you have access to their email now too like mail and email are synonymous you need all that stuff coming to you So that's one thing I did when my mom died, went to her computer, went to the U.S.

49:58Postal Service online thing, and I forwarded all her mail to me for the longest period of time. The mistake I made, of course, because there's a mistake you make everything you do, I didn't forward my father's mail because I figured he's been dead for five years. I don't need to forward my father's mail to myself. But apparently he was still getting mail. if you've been trying to reach my father and he hasn't responded to you it's because he died five years ago i'm sorry i don't have his mail anymore you now need documents in order to go and forward somebody's mail like you need a death certificate and all of that so if you don't do it right away and forward their mail to yourself like you're going to get stuck in like a red tape vortex so try to set that up not everybody gets warning about a death coming not everybody has the ability to do that.

50:48Do whatever steps your local post office says and get that mail forwarded to yourself. And then take a deep breath. Relax for a minute. Do your funeral, whatever procedures your family has for doing that. Every culture has its own rigmarole around death. Don't worry about any of the rest of it because it will all happen at some point and there's no rush for any of it. I wouldn't have listened to that advice if somebody had given it to me. So I understand people out there, they get in a frenzy, they've got to clear things up, they think bills are due. I understand all of that. I would have done the same exact thing.

51:31I got too sick to do it. I literally couldn't talk. I was lying in bed. You know how COVID makes you. You're literally just flat out. That was the only thing that kept me from meddling in everything and driving myself insane. So once I got better, I realized that like, you can't do anything until those death certificates show up. And depending on your state and where you live, it takes a while for those to show up. And you can get very antsy waiting for them. But I had a 10-day period where I was sick and incapacitated. So by the time I got better, the death certificates had shown up. And I was able to then start doing things.

52:13Now, the doing things part is where whatever you've done before death makes it easier for the person after death. There was not that much I needed to do for my mom because she had a trust. So if you are the person responsible for cleaning up the mess after somebody dies, If the person doesn't have any documents, you're in for a world of pain because you have to take the death certificate and go down to the courthouse, get yourself a lawyer and file for some sort of letters of administration is what they call them in my experience. But your court could call them something different. You need to file to be the administrator of that estate.

52:58If there's no documentation that you've been assigned by the person who died as the administrator, then the court will have to make a decision about it. You have to put in a petition. And then you start this like year to two year process of being named the person who can do stuff for the dead person. If your loved one had a will, you can take the will to the courthouse and you can file it and you can begin that process. It sort of short circuits that to the second phase. If the person had a trust, anything that's in the trust is immediate, right? So like my mom left me and my brother, her apartment and all her worldly possessions, and they just belong to us immediately.

53:41So all her jewelry and all the stuff in her apartment and all of that, just ours. Life insurance. She named us as beneficiaries. Just filled out a piece of paper. Money showed up in our accounts. the accounts that we were named as beneficiaries on like her retirement accounts filled out a piece of paper that took a little bit longer everything's difficult in the financial system but it was a process it wasn't hard then we got to one bank account that wasn't properly titled and the money that was in there got locked. So we had to go to probate. And then probate took about a year. Probate's horrible.

54:26Like it's just time consuming and tedious. And I don't understand the purpose of all that tedium, but it exists. And if you have assets that you can't get to, you have to go through it. You want to avoid it if you can. and you avoid probate by having proper titling of assets in bank accounts. Like we had this one bank account. It was a joint checking account that my mother and father had. And after he died, she had never taken his name off the account. When we went to try to fix it, we had to bring all these documents with his death certificate and all of that. And she was sick by that point and we just never got to it.

55:10So I was power of attorney, but power of attorney ends when somebody dies immediately, like dead, no more. So I couldn't do anything with the account after my mother died because power of attorney ceased to be helpful. And so I literally just they just froze the account. And there was twelve thousand dollars in the account and cost five thousand dollars for the lawyer. So you have to do this mental calculus. OK, I have twelve thousand dollars there. I have to spend five thousand dollars to get it. This was my story and my mom's story. Most people would shy away from talking about those kind of financial details.

55:51But I ask people every day to tell me those kind of financial details for the purpose of helping other people. I'm telling people exact amounts because I want to help them. And it doesn't help if I just talk about things generally. Right. So if you can think and understand that if you have$12 ,000 in a bank account, which was carefully calibrated to cover all of the expenses in the month my mother died, we had caregivers to pay, we had her mortgage to pay, her premium for her Medicare supplement. I calculated very carefully the exact number I needed in that bank account to cover the outgoing money, and it just got locked there.

56:35In order to get it out, I had to spend$5 ,000 to get it out. In the story that you just told, we started this interview by establishing that you have the most bona fides in this world that anyone could. You're a CFP. You literally write about retirement planning for MarketWatch. You've been in the financial journalism space for over 35 years. and yet there were still blind spots. There was still these elements of you don't know what you don't know and you don't realize in any anticipatory manner what you're overlooking or what you're missing. What then can people who don't literally immerse themselves in this as their day job, what chance do the rest of us have?

57:25Well, the things that the financial system doesn't do well and makes hard for people are really all about psychology and family communication. If you are a family that can talk to each other, you will make a lot of this easier on yourself just by being in communication with each other. That's not possible in every family and not with every single family member, but it makes things a lot easier. Like my mom's situation with the bank account was more psychological than it was structural, right? She could have gone and changed that bank account earlier, but it felt bad to her. So she didn't do it.

58:05If we could have talked about that, that's more of a psychological issue and an emotional issue than really a banking problem. This is where a financial therapist might also come in handy. Yeah. And I'll say that the number one thing we did right, and that made my life much, much easier. Like all these other problems I would take over not having this problem, which was that I knew what my mother wanted. I knew what quality of life she wanted. I knew what was important to her. And I was absolutely clear about it because she was clear about it. When you are the person responsible for another human being, making hard life decisions is, It's terrifying and it can really mess with your head.

58:57To make end-of-life decisions for somebody else is just really hard. I knew what my mom wanted and I never had to second-guess myself or question anything. And that made everything else acceptable to me. I could deal with the Social Security office because I knew what my mom wanted out of her life. That made it all worth it, for one thing, but I didn't have to torture myself. I didn't have to deal with guilt or negative feelings of any kind because I felt like we were in it together. I felt like I was honoring her by taking care of her in whatever capacity I was supposed to. I didn't have to help her in the bathroom.

59:43We paid somebody to do that. but taking care of her money was a way of honoring her and showing her that I loved her. And honoring her wishes as to how she wanted to live her life was part of that, that she didn't want to be intubated, that she wanted to do not resuscitate order at a certain point, that she wanted to go home on hospice at a certain point in her journey. These were all things she was very clear about and that I did not have to decide for myself for her. And that made a huge, huge difference to me psychologically and emotionally. And all the money stuff was all secondary to that.

1:00:23But that's also a money decision at the end of the day, because how she wanted to be treated medically cost money at every stage of the way. So like going home on hospice sounds like it's a medical and emotional decision, but it's really a financial decision. You have to make that happen. Somebody's got to pay for it. So I feel like we got the big stuff right. And the little stuff took care of itself. But the reason I wrote about it is so that I could help people with that stuff and let them concentrate on the big things. Like, don't let this little stuff run your life. Here's a book that explains to you how to do all of it, all the stuff you need to take care of.

1:01:09Do it, put it on the back burner, take care of the big stuff. Spend your energies on the stuff that matters, not where's my dad's last social security payment. That's a problem that can be fixed. Deal with your relationship with your loved one and focus on that. That's my message to people. That's beautiful. Thank you for spending this time with us. Where can people find you? I am just my name everywhere. So BethPinsker.com, is my website. I'm Beth Pinsker on all social media. On MarketWatch, you can find me as Beth Pinsker. Just Beth Pinsker. Thank you, Beth. What are three key takeaways that we got from this conversation?

1:01:51Key takeaway number one, power of attorney matters more than you think. Many people obsess over estate planning, which is great. That's really important. But power of attorney documents are also incredibly critical because when somebody's alive but incapacitated, there are urgent deadlines and there are bills to pay. Just no. There's not any wiggle room on that. And with a lot of the stuff that you need to do for somebody financially, it's kind of like that. If you don't have that power of attorney document, the answer is no. This can be big stuff like I I can't get into my mom's bank account and I can't pay anybody.

1:02:30I can't pay her mortgage. I can't pay her electric bill. I can't pay any caregivers. I have to pull all this money out of my pocket until we straighten this out. That is the first key takeaway. Key takeaway number two, your phone is the portal to everything. Your phone holds the keys to everything. In today's world, getting access to someone's phone might be the most important estate planning step because that holds the roadmap to their entire financial life. If you open my phone right now, you would know what my car insurance was. You would know what banks I use. You would know where all of my money accounts are.

1:03:08You would know I'm paying a monthly fee to Ancestry.com and my newspaper subscriptions. Like you would know everything I was up to financially. Everything in my life is on my phone. I have heard so many sad stories of somebody gets in a car accident and the spouse can't get into the phone. Right. You lose your pictures. You lose nostalgia items. But you also lose access to things like what apps were they using? What accounts did they have open? What was their email? That is key takeaway number two. Finally, key takeaway number three. You need to physically visit care facilities because if you're choosing where your parent is going to live, there is no substitute for showing up in person and what you find when you visit might surprise you.

1:03:58You have to go to these places and you have to walk in the front door and you have to see what's going on and you have to smell what's going on. You will know the difference viscerally immediately. And you will say, I don't want mom or dad in that place. I went to one nursing home. I remember they were bringing the patients in for lunch at 1030 because they didn't have enough staff to bring people sooner. And so the staff would go and bring one person in, and they'd go and bring another person in. And then the residents just sat there at their long tables for like two hours. Those are three key takeaways from this conversation with Beth Pinsker.

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