Margaret Hoag
“Planning” for a crisis is a bit of an oxymoron. If you have a plan, how can you have a crisis? But many people who care for someone who is elderly understand this term. It may be just a matter of time, but at some point, there will be crisis. We can minimize the trauma by having a plan to manage the crisis when it happens.
Seven Steps to Plan for a Crisis
1. Have contact information available, including back up contacts.
If emergency services arrive at your home, the first place they will look for information is the refrigerator door. It is very important to have all emergency contacts listed, including the contact information for the health care proxy. A list of medications and doctors is also very helpful. Your local Council on Aging can provide you with the File of Life; a red pouch to hold all this important information. If your loved one lives alone, be sure to have this information easily available.
2. Make a back up plan.
Who will take care of your loved one if something happens to you? As unpleasant as it is to consider, it is key to avoiding a crisis. If you, the caregiver, need to go to the hospital, become disabled, or die, what is the plan for your loved one? A back up plan should include a short term plan for caring for your loved one until the longer term plan can be implemented. Perhaps a neighbor can be called to sit with your loved one if you are taken to the hospital, or if you are delayed returning home. If you will need to be in the hospital for several days or weeks, you may want to identify an assisted living community or nursing home which can take your loved one for “respite.” Such communities may have rooms available for short term stays in these situations.
A) If you become completely unavailable to care for your loved one, you should identify people who will serve as health care proxy and power of attorney for your loved one. Update your documents to name these persons as successors.
B) If possible, identify another relative or other person who can take over as the primary caregiver. If this is not possible, you can hire professionals to manage the care. A Life Care Manager (also known as a Geriatric Care Manager) can set up full time home care or a smooth transition to a nursing home or assisted living community. The Care Manager can continue to oversee care even in a community, since there is plenty to oversee and coordinate for persons in a community.
3. Minimize risks.
One of the best ways to plan for a crisis is by taking steps to avoid the crisis. There are many professionals who can assess your situation and help you avoid a crisis. For example, your local police station or Council on Aging can install a lock box so that emergency personnel can have access to your loved one if he or she cannot come to the door. Your loved one may be willing to wear a location sensor or monitor in case of wandering or falling. Avoiding a fall is absolutely key to minimizing risks. You can have consultants check your home for falling hazards and take steps to avoid these hazards. These are just a few examples of steps you can take to minimize risks. Care Managers, the Council on Aging, your doctor’s office, and your regional Elder Care Agency (800ageinfo.com) can all help you identify resources.
4. Have legal documents in place and accessible.
One of the most important steps you can take to avoid a crisis is by having all the necessary legal documents set up well ahead of time. An elderly spouse or relative should sign (at a minimum) a health care proxy, durable power of attorney and a will while he or she still has mental capacity. In addition, you may want a Massachusetts Order for Life Sustaining Treatment (MOLST) and/or a Do Not Resuscitate order to avoid unwanted medical treatment. However, it is not enough to simply have these documents, they must be accessible to emergency personnel as discussed in #1 above.
5. Prepare to have emergency access to funds.
A spouse will not need to worry about access to jointly owned funds. A caregiver child or another relative, however, may need quick access to financial accounts to pay bills. I recommend two methods to prepare for access to funds: one way is to set up a trust, naming the caregiver as successor trustee or co-trustee. For more information, see my blog post “The Care and Feeding of Trusts.” Another option is to take the ill spouse/relative’s Durable Power of Attorney to the bank and have it pre-approved. Some banks will put the Durable Power of Attorney on file, ready to be activated at the proper time. Other banks will only activate a Durable Power of Attorney with a doctor’s letter. It is important to know exactly what you will need to do to obtain access to the funds when they are needed.
6. Assemble a team.
As a caregiver, you need support around you. Your team should include some or all of the following: an elder law attorney, the local Council on Aging, back up health care proxy, back up power of attorney and successor trustee, a geriatric care manager, your loved one’s doctor, and neighbors/friends/relatives who can provide short term, emergency care as discussed above.
7. Plan ahead for Long Term Residential Care.
There are times when long term care in a facility cannot be avoided or may be desirable. You may want to plan ahead by investigating various assisted living facilities, nursing homes and senior day care centers well in advance to find one or two you like and in which you can imagine your loved one living. You could also investigate home care agencies. You may want to select a geriatric care manager and introduce that person to your loved one. Check with your Council on Aging or the Regional Elder Care Agency (see #3) or the Alzheimer’s Association for references and resources.