Originally Aired: December 28, 2015
Topic: Practical Advice on Caring for Aging Loved Ones with Carolyn Rosenblatt and Mikol Davis
The Lange Money Hour: Where Smart Money Talks
James Lange, CPA/Attorney
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- Guest Introduction: Carolyn Rosenblatt and Mikol Davis
- Starting the Conversations
- Naming a Power of Attorney and Telling Them
- Establishing Competency
- Giving up Independence
1. Guest Introduction: Carolyn Rosenblatt and Mikol Davis
Dan Weinberg: And welcome to The Lange Money Hour. I’m Dan Weinberg, along with CPA and attorney Jim Lange. Well, caring for a parent who’s getting older can be a difficult and sometimes painful experience, but our guests tonight are here to deliver some practical ideas and expert guidance that can make that task a little bit easier. Joining us are husband and wife team Carolyn Rosenblatt and Mikol Davis, who specialize in helping people make important decisions about the legal, financial and healthcare issues facing their aging parents. Carolyn is author of The Family Guide to Aging Parents, and she’s a former registered nurse and attorney who represented injured people during her twenty-seven year career. More recently, she and Mikol, a psychologist, started the website agingparents.com. Now, tonight, Carolyn, Mikol and Jim will cover topics like family disputes, caring for aging loved ones from a distance, and protecting those who are aging from financial abuse. As always, we do welcome your questions, so give us a call here in the studio. The phone lines are open at 412-333-9385. Now, let’s say good evening to Jim Lange, Carolyn Rosenblatt and Mikol Davis.
Jim Lange: Good evening, Carolyn.
Carolyn Rosenblatt: Good evening.
Jim Lange: And is Mikol also on the line?
Mikol Davis: I certainly am, but I often let my wife speak first.
Jim Lange: Oh, what a wise man! Anyway, Carolyn is the author of The Family Guide to Aging Parents. It’s just a terrific book, and it provides answers to legal, financial and healthcare questions, and I was reading the book and preparing for the show and I was thinking, “Boy, I’ll bet a lot of people could benefit from this book,” and if it’s okay with you, Carolyn, I’m going to ask you some of the tougher questions because some of the things that you mentioned in the book just didn’t sound like it was so easy to me. Is that all right with you?
Carolyn Rosenblatt: Absolutely, and you’re right. They’re not easy.
Jim Lange: Okay. Well, one of the things…so, I guess you don’t really put an age, but I’m thinking that you’re thinking of adult children with aging parents maybe in their seventies, eighties or even beyond, and one of the things that you write about is you want to make sure that your parents are protected, in terms of medically, financially, that there’s no abuse, and that also that they’re going to have sufficient funds to last the rest of their lives. You say one of the first things to know, at least on the financial side, is what your parents have, and the first question that I would have for you is at what point do you really think that it is appropriate for the adult child to get involved with their parents’ finances?
Carolyn Rosenblatt: In some ways, Jim, it depends a little bit about the parent and their attitude. It also depends on the maturity of the adult children, but sixty-five is the marker. As you know, that’s when the federal government and most state governments would consider you to be an elder and in need of some sort of legal protection if someone wants to abuse you. So, I think sixty-five, the classic retirement age, is a very good time to open the conversation. At retirement is another point that’s a marker in people’s lives, and whether somebody retires earlier than sixty-five or later, that’s a very good time to begin the conversation.
Jim Lange: Well, one of the things that I liked about your book, which, by the way, to me, if you have an aging parent and you are helping that parent, or you’re thinking about helping that parent, and particularly if there’s multiple children involved, I would really recommend The Family Guide to Aging Parents: Answers to Your Legal, Financial and Healthcare Questions by Carolyn Rosenblatt, who has great credentials for this because she is both a registered nurse and an elder law attorney. So, she’s looking at it from both standpoints. Well, one of the nice things about it is that you weren’t general at all. You said, “Okay. Here are some of the questions that you should ask your parents,” and right on page sixty-seven, and I won’t go through them all, but I can easily picture parents not wanting to answer those questions. So, what happens in reality when, you know, let’s say children in their fifties, I was even thinking older than sixty-five, but let’s just say children in their forties or fifties are approaching parents in sixties, seventies and eighties and saying, “Gee, we really want to help you, or even help ourselves,” which I think was one of your strategies. Did parents actually answer those questions?
Carolyn Rosenblatt: Sometimes they do, but I think I’m going to let Mikol take this question a little bit further because of his considerable experience in working with families and having to deliver difficult information to people, and having to talk to people about every manner of complicated thing. The emotional part of this, Mikol, what do you think?
Mikol Davis: Well, we’ve done this a number of times, Carolyn, with so many hundreds of families, and I think the most effective kind of approach that gets the best response from people is that when we speak to our aging parents about being concerned that we don’t want them to become a burden, their existence, we don’t want our aging parents to become a burden on us. They wouldn’t want that to happen, and the way that we can ensure that they’re cared for in the way that they obviously want and that we can do the right job of taking care of them and insuring that their wishes as to how they want to live their life as they get older are fulfilled, it can happen if we do some good planning and that we clearly understand what we’re working with, and if we don’t know that information, then it clearly is going to be a burden where they potentially may run out of money. They could be obviously abused if they start to lose their judgement or their capacity (we call it financial capacity) to look after themselves. And all of these effects could create the horrendous tragedy of their having to wind up in one of those homes that they often tell you that they want you to promise to not put them in. And so, the way that we can ensure that we can respect and ensure that their wishes are followed to the greatest level that is by knowing what the numbers are because what we know is that living longer and caring for our aging loved ones is costing more and more money, of which most Americans we see don’t do a very good job of putting enough money towards retirement.
Jim Lange: And it’s interesting. I actually sometimes have…now, most of my clients are probably in their sixties or beyond, and most of them have, whether you want to call it ‘depression-era mentality’ or they are just naturally reluctant to spend much money, I’m often put in the position of trying to encourage people to spend more money, to make gifts to their children, to go on an extra trip, to sponsor a family vacation. So, sometimes, the parents are actually doing quite well, but if I were the children, I would probably want to certainly know that. I guess what I’m wrestling with is I’m just picturing not only in my own family, but the family of my clients, people growing up that have that depression-era mentality I think are not used to being open about their finances. I know, for example (I’ll just tell a twenty second story), when I was a young CPA, I did the tax returns for an entire family, and I gathered all the information, went back to my office and I did four tax returns: one for a brother, one for another brother, one for a sister and one for mom and dad, and I delivered them to their house and I expected them to, you know, take their respective envelopes and go in their rooms and privately look at them, and they started exchanging them, and I was mortified because it was like little kids saying, “Let’s see your report card!” “Let’s see yours!” And that would have never, ever happened in my family, and I’m just wondering if parents are going to be open to talking to their children about money? And apparently, you’ve had some success.
Carolyn Rosenblatt: Yeah, you know, it’s true. The Depression left a huge mark on a lot of people in this age group that we’re worried about, which is people, you know, maybe in their eighties or nineties now like my mother-in-law. Mikol’s mom is ninety-three. We’ve trained her, shall you say, to be very open because she is vulnerable and she recognizes that. But a lot of people, especially men, who have been in charge of the finances in the family, have a depression-era mentality of secrecy because it wasn’t right, or it wasn’t polite, or it was dangerous to tell somebody else what you had back then when so many people were crashing and burning financially. You know, they have a hard time coming around. But it doesn’t mean they won’t, especially as they see their colleagues, their peers, their siblings, begin to fail physically, and sometimes, when a person doesn’t respond to the “Gee, you don’t want to be a burden on us, mom or dad,” they’ll respond to “Look what happened to your neighbor. He just had a stroke. Nobody had any idea how to care for him, and then he just ended up in that rehab facility and he didn’t have any choices.” I think sometimes using other people as an example is another leverage point because as people age, their peers are beginning to experience health failures. They are beginning to have strokes and heart attacks and cancer and other things that are, you know, the killers in our human race, and so, using those things to help them remember we are all mortal is another way to help persuade them to start sharing.
The other thing I think, Jim, that’s important for people to know is that you don’t just do this in one conversation. You know, I see in the literature, sometimes people talk about having ‘the talk’ with your aging parents. It’s not one talk. It couldn’t possibly be one talk! It’s a series of conversations that help people understand what they’re dealing with, whether they’re going to need to think about supporting an aging parent, or whether the aging parent just needs some encouragement to plan for long-term care. Whatever the issues are, those conversations can build on one another and really help people get a lot more conversant with what is going to happen when the inevitable occurs that one or the other parent is not going to be healthy up until the time they breathe their last breath.
Jim Lange: And what do you do…and I understand you don’t want to make this ‘the talk,’ and I understand that you want to make it about, in effect, the children helping the parents, and you’re kind of helping the children. But I’m just trying to picture some of the listeners saying, “Oh yeah, right! My parents are going to talk to me about money!” And in you book, you have some great stories of people who did not insist on getting the information, and then there was an event and the family was put out because there wasn’t appropriate planning. What do you do when the parent just really resists? And I can very easily picture parents resisting and not wanting to reveal that information and not thinking that it’s even the children’s business, and them thinking, “Well, you guys don’t even save anything. How can you talk to me about money?”
Carolyn Rosenblatt: Umm-hmm. Yeah, I mean, there are a lot of arguments that the aging parent makes to try to beat down the intrusion into their privacy (as they see it). But I think you have to get allies. That’s another thing you can do besides using the points of persuasion that we talked about, like being a burden to the children, or “look what happened to your neighbor John,” you know, all these things. You also can get their best friend, the priest, the rabbi, the influential person in their lives, their lawyer if the lawyer is willing to engage in that kind of conversation and has the client’s permission. You know, you can get a lot done by using other people who are in some way perceived to be less threatening to the aging person than their own kids, and that works too.
Jim Lange: Well, I mean, naturally, as an estate attorney, I have to pick up on the idea of using the existing estate attorney for the elderly parent. Is what you’re saying something like, “Gee, do you think it would be a good idea for us to meet with your estate attorney, review what you’ve done, make sure that everything is covered, and that way, there’ll be complete communication between you, me and your attorney?” I know some clients really want me to meet their children, and sometimes we actually do have family meetings. Has that worked for you in the past?
Carolyn Rosenblatt: Absolutely. I think family meetings are a great idea. I think that people don’t communicate enough about any of these things, and the real underlying motivation, Jim, is that people are afraid of death. Anything having to do with estate planning, as I’m sure you well know, reminds people they’re not going to live forever. You know, it’s been said about our American culture that we’re the only culture in the world that thinks death is optional. Other cultures accept it a lot more and do a better job of planning for getting old and becoming infirm, that happens to so many. So, I think that’s great. I think that if the lawyer is willing to do that, and I’m sorry to say, a lot of lawyers don’t have the communication skills to do a successful family meeting, but for the ones who do, I applaud them. It’s a wonderful opportunity to help educate the heirs, and to help plan for the things that happen to, really, a lot of people. You know, seventy percent of us are going to need long-term care at some point in our lives. We have to talk about this! The odds are not in favor of being totally independent until you drop dead. So, that’s an important thing, using the family attorney.
Mikol Davis: How often is it, Carolyn, that we see that mom or dad have identified an adult child as being either on the power of attorney or on the healthcare directive, and they’ve never communicated that to the adult child, let alone explained to them what their roles and responsibilities are when stepping in and taking over that job?
Jim Lange: Well, I will interject here that that might be the attorney’s fault, because I always tell people, you know, when we’re talking about durable powers of attorney, healthcare powers of attorney, executors, trustees, people that will be in a position of authority, either with the parents alive or even after they’re gone, you always want to make it clear, communicate with people ahead of time, and sometimes they’ll say, “Well, which one should I name? Should I name the oldest one? Should I name the one that’s out of town? Which one’s really going to be the best choice?” And I usually, for all those issues, by the way, executor, trustee, power of attorney, durable power of attorney, healthcare power of attorney, I usually say, “Name the one that you like the least,” because it’s not an honor, it is a burden.
Carolyn Rosenblatt: It’s a nasty job, right?
Jim Lange: Yeah. And then after we chuckle a little bit, I say, “Well, it really is not an insult to the children who are not chosen, and the children who are not chosen, if they know anything about what’s going on, they’ll be actually very happy about it.” So, I don’t know the circumstances where somebody says, “Surprise! You’re the power of attorney. Dad had Alzheimer’s. Now you’re taking over,” just because I insist on knowing that. And by the way, and on the younger side, things like trustee and guardianship for children. You know, like some of the TV movies, you know, “Surprise! You know, you’re now the guardian of a young child.”
Mikol Davis: Well, you know, I think what you do is exemplary in understanding the expanded scope of what your job is. That’s not necessarily what Carolyn and I see among a lot of lawyers in helping their clients best understand what that responsibility is and how to best evaluate of their children how to be able to make that choice, and I can insert a very quick story. Carolyn and I were getting all of our documents together and sharing those with both my parents, who were in their eighties, and delivered the healthcare directive for both of them to sign, and my father very quickly was very pleased to send me back the healthcare directive, of which he identified, on the healthcare directive, my sister and my name equally on the healthcare directive, at which point, I called my dad back and I said, “You know, I’m really pleased that you did what you did, Dad, and that you finally got this together, and I’ve got the document. But I’ve got to ask you something here, Dad. You know, in the last forty-plus years, do you ever remember my older sister and me ever being able to make a decision about anything without conflict?”
I said, “What were you thinking, dad?” And he said, “Well, you know, I just did what I thought was the most fair thing to do.” And I said, “Well, let’s think about this for a second, dad. You’re going to have both my sister and I do the fair thing when it comes to potentially making a decision about pulling the plug? How’s that going to work, dad?” At which point, my dad said, “Well, maybe I need to think about it.” And I helped my dad by saying, “Here’s a better way to think about it. I’m going to elect to take my name off the directive, but I’d like you to think about this: if, in fact, a decision needs to be made about something as serious as pulling the plug, Dad, I think you need to think about whether or not one of your children would be able to best perform that duty and reflect what your best wishes would be, not focusing on their own emotions.” And I think that that’s a great way to think about it. Dad came back the next day. He said, “Well, that was actually a good way for me to think about it because I definitely know that you could probably be the one to do that, because you’d really honor my wishes and yeah, I’m sure that would be a hard one, but I think you’d probably be the best person.” And I said, “Okay, I will accept that responsibility. I hope I never have to do that.” And a year-and-a-half later, I did, and I think that that’s a serious thing that all of us need to ensure that we do with our loved ones way before we get to that point, and that’s why Carolyn and I have been really encouraging families to make these decisions, particularly about the documents. It sounds like you really add value to your clients by insuring that those kinds of critical discussions happen in advance.
Jim Lange: And I really highly recommend, if you have an aging parent, you do want to get a hold of the book, The Family Guide to Aging Parents, by Carolyn Rosenblatt. And where we left off is we were talking about the need to notify children who will become powers of attorney, executors, trustees, and Mikol, who is Carolyn’s husband, who is also with us, said that I do an exemplary job. I actually just kind of think that that’s standard. I think one of the problems (and this probably applies to people living in small towns more) is that the attorneys in some of the smaller towns, in order just to make a living, they have to do everything. They have to be an estate attorney. They have to be a tort attorney. That have to be a transaction attorney. They have to be a real estate attorney. And it’s very hard to develop a lot of experience and confidence in each area, where, you know, I have the luxury of doing no law other than estate law. But things like durable powers of attorney and living wills, I don’t even do wills for people without doing those. To me, it’s necessary and some people say, “Oh, I already have them. You know, how much can I save if you don’t do them?” And I say, “It’s the same price. I just do it as a throw-in.” And you have some pretty nasty stories about what happens when people don’t have powers of attorney or healthcare powers of attorney. Maybe you can scare a few of our listeners into making sure that these documents are done.
Carolyn Rosenblatt: Okay. Well, you know, first of all, we are mediators. We professionally are trained to help people deal with their conflicts, and because we’re both interested in elders and families, we focused our attention on family conflicts. So, we see the fights that happen whether the parent is impaired or whether they’re gone, and we see what happens with poor estate planning or no power of attorney or whatever it is. Those documents are really, really important in preventing people from getting into terrible situations, and I think, really, the power of attorney is so important because people think, “Well, I have a trust. I don’t need that.” And you’d be surprised, Jim. There are a lot of lawyers who do not package that in, or if they had it, it got lost, or whatever the problem is. It’s just not there, and there are plenty of people who scramble and, you know, do some cheapie will, and so they don’t have all the documents that you, as a highly skilled professional, would provide for them.
So, we see the after effect, and the power of attorney, in particular, I want to focus on because we’re very interested in trying to prevent elder abuse. What I see is that if people don’t have one, and then they become impaired and someone wants to take advantage of them, they’re like putty. The impaired elder with brain disease, like Alzheimer’s, is putty. The child, the grandchild, anybody, siblings, can manipulate them into signing a power of attorney. It takes no time at all. In California, at least, you can download the statutory form on the internet, print them out, take them to a notary, and you’re done. Then you’ve got a license to steal or a tool that will help you protect that person, either way. And I think it’s of critical importance that since no court monitors those, since no one has oversight over them, that the person whose estate plan is being put together or revised or updated really needs to think very clearly about who they’ve named as their agent or agents. A couple of rules of thumb I think are so important: one, which you mentioned, Jim, alluded to, is pick the one person. There are lots of people who name everybody and they all have equal voting power, so one person can upend the plan to protect that elder just by saying, ‘No, I don’t agree,” because their signatures are all required. Big mistake. If the person that the elder appointed thirty-forty years ago, or twenty years ago, has gone by the wayside, maybe they’ve developed a substance abuse problem or a mental illness difficulty or whatever, they’re not suitable anymore. That elder now has the opportunity while they’re still competent to change that to the right person who’s going to be more protective of them should they need protection. It’s important for them to get it done, and it’s better to get something you download off the internet and think about carefully and do it yourself than it is to have nothing, because none of us are immune from brain disease. None of us.
Jim Lange: Yeah, I would agree with that. I’m going to add one more potential protection that you can do. While I am definitely a big fan of…and again, I insist that everybody that comes to me have durable powers of attorney and healthcare directives, but also, I encourage people to have revocable trusts, not only to avoid probate, but also because it is easier in the event of an incapacity to take action as an alternate trustee than as a power of attorney. So, let’s say, for discussion’s sake, you know, there’s some bank accounts, there are some stocks, there are some IRAs, there are bills to pay, and just the normal type of financial transactions that families have. With a power of attorney, yes, these things can eventually get done, but boy, what a pain. If you are, instead, the trustee of a revocable trust, or the alternate trustee, let’s say Mom and Dad are the first ones, and then in the event of their incapacity, let’s say, Junior. That is another way to reduce aggravation and administration burden, is by avoiding probate with a revocable trust. Again, always do the power of attorney also, and the healthcare directive, but I’ll just throw in the idea of doing a revocable trust for administration ease, in addition to the benefits avoiding probate. I don’t know if you think that that’s a fair recommendation or not.
Carolyn Rosenblatt: I absolutely think it’s a fair recommendation, and it’s critical because the power of attorney is easy to manipulate as an entrant, and banks are wary of them. Some of them in California won’t even accept a power of attorney, even though it’s a legally viable document that the law says is good. You know, somebody marches into the bank and says, “I’m my mom’s power of attorney and I want to do this or that to the account.” They’ll say, “Well, you need to bring her in.” “Well, she’s in a nursing home and she has Alzheimer’s and she can’t talk anymore.” “Well, you have to bring her in.” They just don’t want to accept it. However, if there is a revocable trust and you can bring that in and you’re the trustee, you’re going to have an easier time. So, it’s very important because I don’t know that the public in general understands the trustee has priority over a power of attorney, at least in my state, and if there’s a conflict, the trustee is going to be the deciding voice, and that’s crucial because the elder may have been persuaded to change the power of attorney, and the power of attorney may be a bad person, the agent who wants to do something wrong to that elder’s money. But if the trustee is a different person and is watching over what’s going on, the trustee can say, “You know, that’s not going to work. I veto that.” And that’s a layer of protection that people just don’t consider sometimes.
Jim Lange: And then what do you do if it’s not totally clear that the aging parent has lost capacity? So, one of the cases that was in the news, of course, was Donald Sterling, who was the owner of the Los Angeles Clippers, and he said some pretty nasty racist things, and some people could say, “Well, obviously, he’s just completely incompetent because anybody that would say those things would have to be completely incompetent.” Although, if we listen to some of our politicians, I’m not sure it’s all that much worse. But do you have an opinion, let’s say, on that case? Was he taken advantage of? It seems to me he didn’t want to sell the Clippers, even though that might have been financially the right thing, I think he built up an empire and he wanted to live the rest of his life as the owner of the Clippers. Do you have an opinion on that one?
Carolyn Rosenblatt: Yeah, and I listened to that case with great interest because he was in, what I call, the gray zone, where somebody is partially competent and partially incompetent, and his wife, I guess, at the time, was very adamant that he was not competent, and it went to court. The issue of his capacity went to court, and Mr. Sterling really shot himself in the foot by misbehaving in front of the judge and being inappropriate, at which time, the court concluded that he was not competent, at least for financial decisions. So, let’s distinguish between competency for some things and competency for other things. You can be competent to say, “I want my son to manage my affairs,” and we call that ‘testamentary capacity,’ testament being a will, and there’s a difference between that and the capacity to make a complex decision about, let’s say, an investment, or selling a professional basketball team. There are different levels, and it’s a sort of continuum, of capacity. We can actually test for it. Donald Sterling, by the way, was tested and was found to be not competent for financial decisions by the testing. But I’d like Mikol to talk about that a little bit because that’s something he does. We offer that service right here in this office when there’s a question about whether somebody can change a document or whether they need to have someone else be appointed to something. You know, Mikol sits them down and does a basic screening. So, Mikol, maybe you can describe what you do and how we measure these things?
Mikol Davis: Well, it’s helpful from an educational point of view just to understand that there are actual tests that have been developed and normed for age and education of different levels to be able to assess different levels of functioning or, what we call, domains, to be able to determine what a person’s level of capacity is in lots of different ways. And what Carolyn was talking about, which we do a lot of, is trying to assess whether or not a person has either testamentary capacity, which has a very low threshold, versus looking at whether or not a person has financial capacity, which involves eight domains, actually, that you assess to try to determine what that capacity looks like and has much more complication. I think what’s more important, just in terms of the public, is that when there is any conflict within a family, there is a way to be able to do actual scientific tests, that neuropsychologists can administer various tests to determine competency, and it’s something that involves pencil and paper and asking questions and assessing a person’s memory, their ability to have long-term memory, short-term memory, their ability to conceptualize abstract forms of reasoning. But there is a way to actually test it so that we get a number, and a lot of times in families, they come to us and they go, “You know, I think mom or dad is having problems with their memory. Is there a way to really find out whether or not they are having problems with memory, or whether it extends beyond that?” And the good news is that there is a way to do some objective measure to come up with answers and say, “Well, you know, your mom does have some problems with, let’s say, short-term memory, but her ability to understand concepts and abstract concepts and do a lot of other things, she’s more than competent to be able to do that. She has testamentary capacity. But there are some concerns that we need to look at that may, in fact, involve financial capacity, because there’s some areas where, obviously, she’s not doing as well, and that’s something we need to be concerned about and maybe we can retest in one year.”
Jim Lange: Well, I would love to continue on this same line, but we have so much…I’m about halfway down on page one of the questions that I had for you.
Mikol Davis: It sounds like some of our webinars!
Jim Lange: So, I did want to talk about…I mean, again, the book that we’re talking about is The Family Guide to Aging Parents: Answers to Your Legal, Financial and Healthcare Questions, and the author is Carolyn Rosenblatt, who is both a registered nurse and an elder law attorney. And one of the things that you recommended, which is something that I often recommend, is to have somebody independent, who is an expert in some of these areas. In Pittsburgh, there is an organization called AgeWell. There are various aging organizations to help people often stay in their home. There might be an organization that provides meals, like Meals On Wheels, and then there’s the Jewish equivalent of that that serves kosher meals, and then somebody else might be a social service agency, and somebody else might come in an do an assessment of the house to look for safety railings or the safety of the bathroom and that kind of thing, and in a rare moment of unity, a number of these organizations got together and they formed a company called AgeWell. Which, truth be it, although AgeWell would not like this characterization, it’s basically some very smart women and a desk, and they are just a great resource, and since you plugged the idea of getting some help at an agency, I’d like to plug them. The organization in Pittsburgh is called AgeWell, and their telephone number is (412) 422-0400. It’s a non-profit organization, although I probably should mention that, to me, the best person on the phone who is very experienced and knowledgeable and helpful is actually a cousin of mine. Her name is Maxine Horn. But you also talk about bringing in other objective people to help make some of these decisions, and you even bring in…you know, we haven’t even talked about decisions like when is it appropriate for Mom and Dad to give up driving? Would that be an example of where a third person would be appropriate?
Carolyn Rosenblatt: Sure. We have a real serious problem with the driving issue because it really represents the ultimate in independence for people, I think, and, you know, part of my work, a large part of my work for the years that I did litigation was representing people who’d gotten injured in car accidents. So, I have some opinions about that, one of which is that I don’t think people who are unsafe on the road should be permitted to keep driving and taking a risk where everybody around them might get hurt or they might kill someone, and it’s a very tough issue for people to approach a parent about because it means the adult child has to be uncomfortable and the aging parent might get really mad at them and, you know, there’s pushback a lot. But the truth is, you know, having studied this issue a lot and written about it a lot, I can tell you that most people, if they’re asked nicely to do it, they will give up driving because they recognize they can’t see as well or they can’t hear as well or they’re forgetting their way. I think that, you know, Mikol’s mother at ninety-three is a really good example. The first thing she did was voluntarily limit her driving at night because she’s got some vision problems associated with aging (macular degeneration), and she recognized that the glare was making it hard to see, so she stopped driving at night, and at this age, she is considering, within the next few months, moving into a senior’s community where she’ll be in an apartment and there’ll be people around her, so she’s giving up living independently in a house and a car now. You know, she’s going to give up driving too altogether because they provide transportation to the doctor. It’s kind of an ideal outcome.
Most people don’t have it that ideal. But I think if you can use anybody, if the parent resists, if you can use anybody outside the family or in the family who has influence over the elder, there are several ways to make it work. One is, they have to be able to get around. You know, you don’t want to sentence them to the prison of not having transportation. People who live in rural areas have a terrible time with this because family is the only way they can get anywhere, or maybe some neighbor, but they’re stuck. In urban and suburban areas, there are more services. In my county, which is a fairly small county with a couple hundred thousand people, there is, you know, a transportation service that’s associated with a senior center, and you can dial a ride. You can call and make an appointment for your doctor’s visit or your trip to wherever you need to go, as long as you do it in advance. There’s a very reasonable fee, much cheaper than a taxi, and that works. Otherwise, when people say it’s time to stop driving, they haven’t really thought about what it’s like to be that person who no longer has the independence of going where they need to go or where they want to go, and I think that consideration and a respectful approach by acknowledging how hard it is is really useful.
Jim Lange: And we are here with Carolyn Rosenblatt, who is the author of The Family Guide to Aging Parents: Answers to Your Legal, Financial and Healthcare Questions, which is just a great book. I’m not going to get to half of the issues that I wanted to talk about, for example, how you pick a homecare worker and if you should consider assisted living and the difference between assisted living and a nursing home and the continuum of care communities. There’s just a lot of things that we’re not going to have time to talk about. But there is something that, Carolyn, you mentioned that I personally had a huge fight with my mother about, and this went on for years, and you said as people age, they sometimes lose their hearing, and my mother and I fought for years on her need, maybe it was my need, but I used it as her need, to get a hearing aid, and could you tell some of our listeners how they can approach that fight? Because I suspect that that’s a pretty common one.
Carolyn Rosenblatt: It’s very common, and I noticed that, when I worked as a nurse, there are a lot of people out there who need some kind of assistive device, whether it be a walker, or a wheelchair, or a hearing aid, or different kind of glasses, whatever it is. They don’t want to do that because that means “I’m getting old,” and it goes back to the fear of being dependent, fear of death, fear of having to have someone take care of you. It’s very, very complicated. It’s not as simple as, “Gee, you can’t hear. Why don’t you get something that helps you? For gosh sakes, what’s your problem?” It really isn’t about logic, Jim. It’s about emotion, and it’s very hard to dissuade someone from whatever emotion they’re holding onto. They’ve got their emotions and they’re important and, you know, we have to acknowledge them.
I think it’s very important to, first of all, recognize and tell someone, “Look, this may be hard for you, to say you can’t hear me, but I’m getting tired of repeating myself. It’s really, really very trying on my patience. What do you think we can do about that?” And sometimes, doing the research, for us, because we’re younger, it’s a piece of cake. We get on the net. We look around. We see what the prices are. We compare. Older people may have a harder time collecting that kind of information that makes it easier for them to buy something like that. Hearing aids are not covered by Medicare. They cost thousands of dollars. With hearing aids in particular, that’s one kind of device, that there are reasons other than “I’m getting old and I don’t want to do it” that make it hard for people. It’s also uncomfortable. Mikol has hearing aids. You know, he’s sixty-four. He takes them out the minute he gets home and then I’m repeating myself! So, I get it, but I also recognize, for him, they itch, they sometimes cause things to echo, and he has good ones. They’re thousands of dollars, as I say. So, that is the resistance some people have. But that applies across the board. You know, my mother-in-law didn’t want to get a walker, and she was holding onto the furniture and her knees were bad and I was so afraid she was going to fall. I just took her down to the medical supply place one day when we were on vacation with her and said, “Let’s just try one out.” “I don’t need that!” I said, “Oh, let’s just try one. Humor me.” And she did, and she was walking so much better. She still doesn’t like to use it, but she knows it’s there and she will use it when she has to go someplace where she’ll be walking a little bit longer. So, you know, it’s kind of tricky. You have to use whatever persuasion you can, but it is an emotional decision for most people.
Mikol Davis: But you also forget how it affects the quality of your life, like hearing. You know, when you don’t hear so well, you’re not as keenly aware of how much you’re losing, and so that’s also a part of the dynamic, is that people forget, and they get used to having a much more limited perspective or perception of the world around them, especially when their wives talk to them!
Jim Lange: Well, I will tell you. I had a brutal fight with my mom. It was years, and eventually, she wore one, which made about no sense to me. Then, as she was in her early to mid-nineties, she had some walking problems, and in Pittsburgh, there’s a guy named Howard Diamond, who is actually a podiatrist that went on to get advanced training in walking and balance, and he was very helpful in helping my mother with certain exercises to walk better, and, interestingly enough, one of the things that he wanted her to do was to wear her hearing aids because that would make her a better walker, that she would be able to hear what’s going on and have better balance. So, that was another reason. But I will just tell you, I have personal knowledge of that fight, and that wasn’t pleasant at all.
Carolyn Rosenblatt: That’s a tough one, and it’s tough for a lot of people because it’s very annoying, frankly, to have to keep repeating yourself or speaking up for someone who doesn’t hear you, and they keep saying, “What?” But I think we all just have to try to be more patient because we could be that person someday ourselves.
Jim Lange: All right. And one of the things I want to ask about is long-term care insurance. And by the way, we might disagree on this one, and that’s okay, and I think we only have three minutes, so I’m going to ask both of you what your opinion is. Are you fans of long-term care insurance in general, or is it a case-by-case basis?
Carolyn Rosenblatt: Definitely case-by-case. It is not for everyone. It is expensive. People don’t necessarily want to insure against risk. The insurers who wrote these policies initially were thinking they’d make lots of money because people wouldn’t really cash in on them. Then Alzheimer’s became such a big problem, and they are cashing in on them, and the insurance companies were losing money, or not making as much as they anticipated, so they solved that problem by raising premiums. That makes it much less of an incentive for people to buy. However, they’ve also created a lot of newer products associated with life insurance and other kinds of insurance, so it’s a little bit easier, but I still think it’s a very controversial subject.
Jim Lange: Yeah. By the way, I’d love to talk about this more. In general, I’m not a huge fan of traditional long-term care for a couple reasons: one, if you die, you lose the money. Two, like you mentioned, you said the costs are going up. You can buy a policy and then they can jack your costs up, and then you have the bad choice of either paying the additional premium or giving up the coverage. But you also mentioned, they have some newer products that actually combine life insurance and long-term care. So, let’s say you get a $500,000 policy. If you need it for long-term care, it’s there. If you don’t, and then you die and you never used it, then it pays out as life insurance. So, that’s one of those, let’s say, combinations. And I am getting a one minute warning, so I’m going to say that it has been a pleasure to talk with you. I wish we had more time. You have been a wealth of information, and there’s a wealth of information in your book, and we’re talking about the book called The Family Guide to Aging Parents: Answers to Your Legal, Financial and Healthcare Questions by Carolyn Rosenblatt, who has the ideal credentials because she is both a registered nurse and an elder law attorney, and we have also been joined by Mikol Davis, who is her husband, who is a psychologist, who, together with Carolyn, has a mediation practice in California that I’m sure would be very good if you lived there and had these kinds of problems. But again, thank you. The book is The Family Guide to Aging Parents: Answers to Your Legal, Financial and Healthcare Questions by Carolyn Rosenblatt.