Eldercare: How to Avoid Sibling Discord

by Janet Simpson Benvenuti

Recently I teamed up with geriatrician Dr. Leslie Kernisan to share how to minimize family conflicts that arise even in the closest of families when a parent or older relative becomes ill and needs support. Dr. Kernisan is a practicing geriatrician with an active interest in educating seniors and their adult children how to achieve Better Health While Aging.

Sibling conflicts arise from a lack of clarity about roles and responsibilities that change as a parent’s or older relative’s needs increase. Geographic distance, job demands, financial strain and even denial will elevate stress and tension. In this podcast, you’ll learn the key roles relatives play and the four actions that insure successful aging. Learn, too, how a quick sketch of a family tree helps identify and fill gaps in support long before assistance is needed.

Like you, I often listen to podcasts on walks or when commuting. I listened to our edited podcast on a rainy day while chopping vegetables to prepare beef barley soup. Here is the recipe and the podcast.

c Circle of Life Partners, LLC. All rights reserved.

Campus Alert: You Forgot Something, Mom. The HIPAA Release

eos_yale_firstsession015by Jan Simpson Benvenuti

Whew. What a summer. Your son or daughter is now settled into their dorm, engaged with classes and ready for the year ahead. You’ve celebrated their high school graduation, savored their last summer before college, checked off the list of items for the dorm. You found those extra-long sheets, fresh towels, and a small fan; you met the roommates and unpacked the clothes; you lingered at the door, hesitant, nostalgic, wondering where the years went, praying that you’ve done enough, that the next four years will transform your child from a capable adolescent to a competent young adult.

You’re excited for them, but you’re worried, too. You follow the news. You combed through the Department of Education’s Campus Safety and Security website, noting the number of Criminal Offensives, Rapes, Robberies and Assaults reported on campus for the last three years. You know that freshman and sophomore girls are particularly at risk. You’re aware of the binge drinking statistics, and that the collective IQ of testosterone-laden adolescent males decreases in packs. You’ve heard that 20% of young adults, one in five, will experience mental health issues like anxiety or depression. You know these things, but you also know that you’ll be there for him or her, whatever transpires, just as you’ve supported them for 18 years. In fact, you’re making plans to revisit the campus soon.

But you forgot something. Your child is 18, and at 18 they become legally responsible for their own medical decisions. That’s right. Even their pediatrician, someone you’ve known for 18 years, can no longer disclose their medical information to you. It’s illegal to do so. So if your son is taken to the emergency room or your daughter seeks mental health counseling, the physicians and psychologists have no legal right to discuss their health with you. They may not even contact you.

Fortunately, the solution is a simple one. You don’t need to contact an attorney, just have your teen sign a HIPAA Authorization Form. Reply to this post or send an email to info@colpartners.com. We’ll send you a copy of the form with instructions. Bring it to campus. Have them sign it. Put a copy in University Health Center and keep a copy for yourself. Call this preventive medicine. Hopefully, the accident won’t happen, the call won’t come, they will navigate the college years without incident. But should they need your help, you’ll be able to quickly support them, just as you’ve always done.

c Circle of Life Partners, LLC. All rights reserved.

Is your Teenager Turing 18? Protect Their Health

by Janet Simpson Benvenuti

Do you have a niece or nephew, child or grandchild turning 18 this year? Be sure to have them sign a HIPAA Authorization Form before leaving home for college. Many parents of college-aged students are surprised to learn that they can not access their teenager’s medical information without their explicit permission, a right to privacy embedded in HIPAA legislation. Some parents discover they’ve been denied access in the middle of a medical or mental health crisis, a situation easily avoided by having your teenager sign a permission slip called a HIPAA Authorization Form on their 18th birthday. This form, which takes only a minute to complete, does not require an attorney nor notarization.

Listen to my video and request your free copy of the form, with easy instructions, by simply replying to this blog post or emailing info@colpartners.com with HIPAA in the subject line. Make this task a priority, on top of your “to-do” list, ahead of finding the twin-extra long sheets for dorm beds.

Please share this message with friends and family who have teenagers. Don’t let them leave for college without signing this document. Here’s why from Consumer Reports.

c Circle of Life Partners, LLC. All rights reserved.

Are You One of the Village People?

by Janet Simpson Benvenuti

Next Thursday, June 30th, I’m heading to Cape Cod to join the Village People. I won’t be donning my cowboy boots or singing “Y-M-C-A” but I will be leading a fun, community-wide conversation about aging and aging in place with Neighborhood Falmouth, one of the first virtual retirement villages in the United States. Joining our conversation will be experts in law, financial planning, home care and senior housing along with working daughters juggling aging parents and teenage children, Baby Boomers planning for their own longevity, and a random cowboy or two. If you’re heading to Cape Cod for the fourth of July, especially if you’ll be spending time with your older relatives, stop by and join the conversation. Learn why fewer Baby Boomers will be using senior housing. No singing skills required.

Here’s where we’ll be on Thursday, June 30, 2016, 7pm-8:30pm: Unitarian Universalist Fellowship of Falmouth, Sandwich Road, Falmouth.

c2016 Circle of Life Partners, LLC. All rights reserved.

BOOK REVIEW: Being Mortal by Atul Gawande

by Janet Simpson Benvenuti

Let’s talk about death, or better yet, dying. Our guide is Dr. Atul Gawande, brilliant surgeon and best-selling author, who weaves a compelling narrative that informs, enlightens and challenges clinicians and senior housing leaders to improve the way our institutions of care impact lives. Unlike his previous books The Checklist Manifesto: How to Get Things Right, Complications: A Surgeon’s Notes on an Imperfect Science, and Better: A Surgeon’s Notes on Performance, Gawande gets personal in Being Mortal: Medicine and What Matters in the End, with a perspective enriched by his father’s end-of-life journey. “We are not ageless,” Gawande writes, pushing readers past the denial that afflicts both the physician and the patient. Our goal, he continues, is “not a good death, but a good life to the end.”

The challenge, of course, is how to achieve that goal when only three percent of medical students receive training in geriatrics. While Gawande and his colleagues at Ariadne Labs focus on physician education, Being Mortal provides insights that readers can use with their own families.

My favorite tip was his description of ODTAA Syndrome, the signature way to tell when a patient or loved one is nearing the end of their lives. ODTAA Syndrome is when one experiences “One Damn Thing After Another,” a sure sign that the body is weakening and starting to fail. While the medical community uses clinical markers and checklists for stages of dying, this intentionally amusing name most clearly describes what families experience.

Long before ODTAA syndrome begins, older people with medical concerns face three housing choices: aging in a home setting with assistance, moving to an assisted living community, or moving into a skilled nursing home. While each option has benefits and challenges, Gawande describes resources worthy of consideration.

1. The Eden Alternative – As a new medical director of Chase Memorial Nursing Home, Dr. Bill Thomas found that residents were suffering from boredom, loneliness and helplessness. His solution? Admitting 100 winged and six four-legged residents. Gawande shares this hilarious story about the founding of the Eden Alternative; you may find nursing home communities that subscribe to their philosophy here.

2. Assisted Living Communities – As a caution to families, Gawande reminds us that today only 11 percent of assisted living communities “offer both privacy and sufficient services to allow frail people to remain in residence,” the original intent of Dr. Keren Brown Wilson, the founder of the first community for assistance in Portland, Oregon. One of the model organizations recorded by Gawande is Sanborn Place, led by friend Jacquie Carson who provides the kind of passionate advocacy and skilled care all elders deserve.

3. Palliative and Hospice Care – Perhaps the most useful guidance in Being Mortal were the examples of how patients, including his father, weighed treatment options during the last few years of their lives. Highlighting the importance of palliative consultations and hospice care, Gawande used his father’s fear of becoming a quadriplegic to demonstrate those often difficult conversations about care options, conversations that are the focus of the 5 Wishes, The Conversation Project, and the popular card game My Gift of Grace.

Here is an excerpt of the questions a physician trained in palliative care might ask.

1. What do you understand your prognosis to be?
2. What are your concerns about what lies ahead?
3. I need to understand how much you are willing to go through to stay alive.
4. What are your goals if your condition worsens?
5. If time becomes short, what is most important to you?

Unfortunately, until more physicians and health care providers are trained in palliative care, it remains for family members, especially those who are designated as health care agents, to clarify their loved one’s wishes. Being Mortal gives families insight into how to have those conversations. Buy a copy and use it to start the conversation with those you love.

HIGHLY RECOMMENDED. You may purchase a copy here.Being Mortal: Medicine and What Matters in the End

c 2014 Circle of Life Partners, LLC. All rights reserved.

Broads Talk Money, Careers and Families

Professional Womenby Janet Simpson Benvenuti

On June 5th, I’ll be joining a panel of financial advisors in Boston to discuss the unique financial challenges that women need to manage over the course of their lives and careers. As members of 85 Broads, we are committed to the economic empowerment of women. As founder of Circle of Life Partners, I’m committed to helping adult children – men and women – successfully support their aging loved ones without negatively impacting their careers, health or financial well-being.

Free and open to non-members, encourage the women in your life – colleagues, spouses, sisters, and college-aged daughters – to join us and learn how best to avoid or navigate financial mistakes and increase financial confidence. Click HERE to register.

June 5th, 5:30 – 8:00 PM
Federal Reserve Bank of Boston
600 Atlantic Avenue, 4th Floor
Boston, MA

Panelists:
Cathy Burgess, Morgan Stanley, CFP, ADPA
Janet Benvenuti, Circle of Life Partners, Founder
Deirdre Prescott, Sandy Cove Advisors, President & Founder
Dionne Gumbs, Wealthrive, Founding Partner

Moderator:
Kathleen McQuiggan, 85 Broads Boston Chapter Co-President

© 2014 Circle of Life Partners, LLC. All rights reserved.

Know Your Money: The True Cost of Long Term Care

Calculating the Cost of Care

Calculating the Cost of Care

by Janet Simpson Benvenuti

Recently I asked our financial advisor to do some retirement planning and estimate expenditures through the end of my life. To my surprise, my husband and I both are going to die at age 87 (for the record, I will predecease him), spending $100k/year in today’s dollars for each of the last three years of life. Amused, I wondered where I would find care for $100k in Massachusetts. The last assisted living facility with a memory unit I visited cost $8700/month without hairdressing or a personal care attendant. I’m sure to need both. And only three years of care? Prudently, one would plan for at least six, and with any history of longevity or cognitive impairment, I would plan for 12.

That same day, I spoke with a different financial advisor whose 91 year old client has Alzheimer’s disease. He and his spouse reside in Connecticut and spend a more typical $15,000 a month for assisted living with an aide for additional support, $180,000/year. When I reminded that advisor that home care for someone with Alzheimer’s disease is tax deductible as a medical expense, she expressed surprise, unaware of IRS Publication 502.

What’s going on here? Why are financial advisors so ill-informed about the true cost of care?

Quite simply, few people, including financial professionals, understand the extraordinary cost of long-term care and the options available to manage expenditures wisely in the last decade of life.  Effective financial planning requires more than just the skills to create an investment portfolio or project future expenses, but integrated knowledge about finance, elder law, insurance, health care and inexpensive community resources for aging in place. It’s why I founded Circle of Life Partners.

I’ve been guiding families through the aging journey for years, yet I still find the numbers shocking. Recently, I received a call from a family of three adult children who were growing concerned about their mother’s ability to care for their father safely at home. He was three years past his initial diagnosis of Alzheimer’s disease and the family felt he might be best served by moving into an assisted living facility with a memory unit although he did not have long-term care insurance. I calculated the price tag for nine years in a highly-regarded memory unit and subsequent skilled nursing care, $835,000- $1.25 million. Using an adult day health program or a part-time companion suddenly seemed a much more reasonable option.

Last week, I wrote about the Bipartisan Policy Center (BPC) launch of a new initiative on long-term care led by former Senate Majority Leaders Tom Daschle (D-SD) and Bill Frist (R-TN), former Congressional Budget Office Director Alice Rivlin, and former Wisconsin Governor and Secretary of Health and Human Services Tommy Thompson.  BPC’s Long-Term Care Initiative will propose a series of bipartisan policy options in late 2014 to improve the quality and efficacy of publicly and privately financed long-term support services. Read the white paper here to learn more and follow their work @BPC_Bipartisan.

Let’s hope they can get their arms around this issue. Until they do, I’ll continue guiding families to the resources they need, until I need the same support, at age 84.

©2014 Circle of Life Partners, LLC. All rights reserved.

More Boston Seminars on Aging Parents: Navigating the Journey

by Jan Simpson Benvenuti

The fall has been busy as our Aging Parents seminars that bring the experts and families together continue to grow in popularity. My last two public programs offered in Boston for 2012 are noted below. I hope that you or your colleagues can join me.

Two weeks ago, I spoke to an overflow crowd of Harvard-educated executives as they shared their stories about navigating the aging journey with their parents and reflected on how to improve programs for employees within the organizations they lead. Last week, I moderated a panel in Wellesley, MA to help families better understand how to care for their older loved ones and themselves as they juggle work, family, and other responsibilities. This week, I’ll be moderating a program hosted by the Women’s Bar Association in downtown Boston on Thursday evening that is open to the public. And, on Saturday November 3rd, I’ll be speaking in another public event in Boston at the National Association of Healthcare Advocates’ Conference. If you have a personal interest in attending one of these programs on Aging Parents or if you know others who would benefit from expert advice for the price of a latte and a snack, please plan to attend if your schedule permits. Both events require registration, but last-minute registrants are welcome.

  • Thursday, October 25th at Baystate Financial, 200 Clarendon Street, Boston @ 5:30 p.m. Click here to register.

The Women’s Bar Association of Massachusetts is hosting this informative evening on Aging Parents: Navigating the Journey ™. As moderator, I will be joined by Martha Payne, Financial Advisor, Baystate Financial Services; Dianne Savastano, Principal, Healthassist; and Kristin Shirahama, Esq., Partner, Rosenberg, Freedman & Goldstein LLP. Proceeds from the sale of my book Don’t Give Up on Me! will be donated to the WBA’s Elder Law Project.

  • Saturday, November 3rd at the Hyatt Regency in Boston @ 11:30 a.m.  Click here to register.

The National Association of Healthcare Advocacy Consultants will hold its fourth annual conference in Boston. This three-day conference includes medical professionals and experts convening to discuss The Leading Edge of Reform: Roles and Goals for Healthcare Advocates. The Saturday program is open to the public for $25. My session will include a mix of families and the healthcare professionals who advise them. All workshop participants will receive a free copy of Don’t Give Up on Me!

I’m grateful that so many professionals donate their time and expertise to our educational programs. We are planning the 2013 calendar now, so stay tuned as we host programs in cities across the country.

 

© Circle of Life Partners LLC

 

Aging Parents: Navigating the Journey Seminars

Our mission at Circle of Life Partners is to provide the knowledge families need to navigate the aging journey with elders successfully. This month, I’m taking our program to executives at the Harvard Business School reunion, families in the town of Wellesley, MA and attorneys at the Women’s Bar Association. See below for the incredible people who will join me to share their experience and expertise with others.

On the Road Again…

Harvard Business School (not a public event)

Saturday, October 13th, 2:30-3:45 p.m. Aldrich 107

Executives attending their 25th through 45th reunions will participate in a discussion about the key decisions and resources available to navigate the aging journey with older loved ones. The panelists will include Rich Redelfs, General Partner, Foundation Capital LLC,; Jane Beule, Owner of Griffin Black, Inc., a financial advisory practice; and Ken Bacon, retired EVP of Fannie Mae’s $193 billion Multifamily Mortgage Business and Advisor to Stanford’s Center on Longevity. Follow me on twitter at @colpartners as I moderate the panel.

The following week, I’ll be moderating a public forum in Wellesley, MA sponsored by Princeton Alumni of New England (PANE), the Wellesley Free Library and the Wellesley Council on Aging. This program continues my series of public events that bring together local resources and families. The profits from any copies of Don’t Give Up on Me! sold during that event will be donated to the Wellesley Council on Aging .

Wellesley Free Library – A Free Public Event – Click here for more information.

Wakelin Room, 530 Washington Street, Wellesley, MA.

Wednesday, October 17th 7:00p.m. to 9:00 p.m.

The theme for this free public event is “Caring for Our Parents and Ourselves.” The panel will include four speakers: Dianne Savastano, RN, MBA and founder of Healthassist who will share tips for navigating the health care system; Jim Reynolds, CEO of Caring Companion Home Care, who will help families understand how to select a home care agency; Dr. Anne McCaffrey, Chief Medical Officer of the Marino Center for Integrative Health and Debra Brothers-Klezmer, BSN, who will share strategies for reducing the stress that often accompanies family caregiving.

If you’re in the area, stop by for what’s sure to be an informative and engaging conversation. No registration is required.

Dianne Savastano will join me on the road again the following week as we provide another program for the Women’s Bar Association of Massachusetts. Appropriately, this event includes panelists who will share cases that demonstrate how legal advice and financial planning can smooth the aging journey.

Women’s Bar Association – Click here to register for the event.

200 Clarendon Street, 19th floor, Boston, MA

Thursday, October 25, 2012  5:30 p.m. to 7:30 p.m.

Joining Dianne and me on the podium will be Kristin Shirahama, Esq., Partner at Rosenberg, Freedman, and Goldstein, who will describe a complex case involving disability and how she helped that family get the financial resources needed to care for that older loved one well through their later years. Martha Payne, a financial planner for Baystate Financial Services will provide guidance for how to prepare financially for the aging journey with one’s parents.

At Circle of Life, we are committed to your health and well-being. Construction of our new website is underway and until it is ready, we will continue to keep you informed about upcoming events through this blog. If you want to be on our  mailing list for a personal invitation, just post a reply.

© Circle of Life Partners

 

 

 

 

 

 

Your Legacy: Money, Mementos and Memories

By Peggy McGillin, CFP®

How do you want your children to remember you?

There’s a loaded question for you. I’m moved to ask it because of all the stories I keep hearing. They’re sad because the outcomes could have been so different. Here is one particular story that I’ve heard over and over again with slight variations.

The patriarch of a strong and proud family dies. This man was an accomplished and respected member of the community who held high standards for himself and his family. His children were loved and well provided for, and although (or perhaps because) he was known for being a strict son of a gun, they’re all productive adults.

Whether widowed or divorced, at some point the patriarch remarried. And, whether due to negligence, ignorance, bad advice, apathy, conniving, or spite, the new wife has now inherited everything. It’s her prerogative to pass along the “family treasures” as she sees fit: the silver from Mother’s side of the family, that signed baseball, Father’s flight jacket, those coveted season tickets, and, of course, all the money. To add insult to injury, she has her own kids from a previous marriage. So now, her children are summering at the cottage where the patriarch’s kids spent every summer of their lives until now.

This is not a story about evil stepmothers. This is about parents who just didn’t think it through or get it done. Perhaps, in some cases, this is indeed what Dad or Gramps truly wanted. More likely, he just ran out of steam along the way and couldn’t muster the motivation to attend to an estate plan.

Everyone knows that nature abhors a vacuum, and when the human mind doesn’t know the reasons for something, it tends to write a narrative to make sense of the situation. So carefully study the following words:
• Negligence
• Ignorance
• Bad Advice
• Apathy
• Conniving
• Spite
This is not a flattering list. I’ve been told by Howard McGillin, a family member who is an estate planning attorney in St. Augustine, Florida, that the number one reason people call to make an appointment with him is because the new client just attended the funeral of a friend or sibling who everyone agrees was far too young to die. It’s the stark reality about mortality that gets you thinking about how precarious your plans are.

No matter what ultimately motivates you, ask yourself, don’t you want to be the one who is calling the shots? Don’t you want to have a hand in how you’ll be remembered by those you brought into your world?

And, one more minor consideration: if you don’t attend to this, your estate will go through probate, which means it is public information. If you value your privacy and the privacy of your survivors, you will schedule this “someday” item on your to-do list: find an estate planning attorney before the end of next week.

I could shower you with all the benefits in doing so and the risks in not doing so. However, like your average teen, you’d probably tune me out even if it meant that you’d be giving up the most generous gifting opportunities in years, just as you’re not likely to dwell on updating your homestead protection due to recent changes, and these are mere details.

But, what I hope truly motivates you to get this done before it is too late is the thought of how you’ll be remembered by your children for the rest of their lives. It’s not very difficult or expensive to address these issues. You’ll need a will, a living trust, a health care proxy, a durable power of attorney, and most likely a trust; in addition, you will need to have your assets titled properly and make sure your beneficiary statements are updated to reflect your plan.

If I’ve helped to open your eyes, please let me know. I’d like to be remembered as the one who was looking out for you and your family. If you care at all about your legacy, get to it.

Peggy is the owner of Journey Financial Planners. To read her monthly blog, click here.