Thank you for asking this question. It is something on a lot of people’s minds and hearts when they are caring for their parents. It can be a big worry.

Your parents’ situation is different from that every other set of parents. Your question leads me to want to ask you a lot of questions so we can get down to a response specific to your family, like: 1. Are your parents both still alive? 2. Are they married and living together? 3. Is one or both in the nursing home? 4. Do they own a home? 5. What assets do they have? 6. What is their monthly budget? 7. Is either of them a war-time veteran of the US Armed Forces? 8. How many children do they have, and how are each of them willing to help? 9. What do your parents want to accomplish? 10. What approaches are you considering? (I will email you privately to ask you these questions, so we can be a little more specific in our exchange.

Elise and Fred (not their real names) were trying to figure out a way to pay for nursing home for Fred. They had $500,000 in assets. We worked out a plan for them that was legal and would have protected all these assets. I say would have because they decided that they felt a moral duty to pay a larger share of his nursing home costs. This is quite reasonable, and I supported them in this decision.

Medicare can help, but statistically it pays a very small part of nursing home costs. Trusts sometimes are a tool we use, but there are other, simpler things to try first.

The Veterans Administration can help, but the maximum they provide is around $2,000 a month, so they best help with assisted living or living at home. They are relatively easy to qualify for, but it takes 6-12 months to get approved.

Medicaid is the program that pays the most, but it is harder to qualify for than V.A. Your assets need to be less than $1,500, and they assess penalties for all gifts made within 60 months of applying.

That said, there are many ways to protect your parents’ assets so they can qualify and have a good quality of life. Maybe they should seek to qualify for Medicaid. Or V.A. Or both. Or neither.

It is nevertheless a dark and overgrown forest you are trying to navigate, and this is where the elder caring attorney can help you find your way. That is, he or she can help you find a path that steers your parents through this woods from where they are now.

Don’t try to go this alone, or even with a lawyer who is not an elder caring attorney. No, you should not rush out and give your parents’ assets to their children…if they want to apply for Medicaid some day. But it might be the right thing to do for V.A., if that is all the help they will ever need.

See what I mean about this being very specific to each family? It is also very much a conversation to try to see what really fits. You tell me one set of facts, and that suggests one strategy or approach. Then you say, that does not work, because your brother would not be able do his part in the plan. So we suggest something else. And we go back and forth.

Beth, please remember that this question and response does not establish a client-attorney relationship between us, nor between us and your parents. Nor should you use what is posted here in response as a roadmap for you to follow or put into effect. The only thing you should do is to get specific advice from a competent elder caring lawyer. Too much of your parents’ well-being depends on it.

Let’s talk a few specifics in private email and see if we can narrow down the response for you, Beth.

Thanks for posting!

:- Doug.

To Doug

You are not in my will
But you are in my thoughts
My life is richer for you being there
And funner too
Reframe reframe
Hmm, maybe I will put you in my will
To whom will I bequeath thee.
I know,
The world.

Mike

:- Doug.

* [Completed] Saturday, March 17, 2012, from 2:00 pm to 4:30 pm at Cathedral of St. James, 117 N. Lafayette, South Bend, IN

* [Completed] Sunday, March 18, 2012, from 6:00 pm to 7:30 pm at Trinity Evangelical Free Church, 61770 Miami Road, South Bend, Indiana 46614. (This is the second half of the video; the first half was shown March 11.)

[We are scheduling more with other organizations, so please check back. If you would like to schedule one for your group, please call us at 574/291-0022.]

Some hospitals today have added palliative care to services they offer, and they do just what you were asking for. So some doctors do these things, but it is unusual. The kind of consultation your client’s family is asking for was a part of the originally-proposed health reform package, but that was taken out after loud accusations that the government was supporting “death panels.”

When my father-in-law was nearing the end of his life, we sometimes took him to his doctor appointments, and could usually find time for conversation about his prognosis, after the doctor attended to the immediate problem. Care conferences with the nursing home staff were helpful, but I do not remember the doctor attending the conferences. A social worker at the hospital was helpful in resolving certain issues that came up during a hospital stay.

I think it might be possible to find a doctor that would provide the kind of care you are wanting for elderly clients. You might look for a gerontologist, whose practice is more attuned to older patients. Ask around to see if someone can recommend a doctor who is willing to spend more time when needed. They may have an independent practice, rather than being part of a large clinic. Older, more experienced physicians might have these qualities. On the other hand, you might find a young woman who has a lot of idealism and empathy. You are absolutely right about what is needed; don’t give up on it.

“I think there are some physicians that will revert into the role of technician, especially considering some of the regulations coming down the line. However, there are many others who are actively involved with planning care for their patients. We see a wide array of approaches in the physicians we work with. I think the issue becomes amplified in facilities due to the nature of the care provided and acuity levels, plus the multitude of physicians involved. Often times, that leads to the question of which one is responsible for what… kind of like too many cooks in the kitchen and who is the head chef?”

Thanks for letting me post your response.

So if we want to find out about how our loved one is progressing, what their prognosis might be, and what the best course of treatment is, especially in the nursing home, we need to rely upon the nurses and social workers? This can be good, because they know what is going on with Mom or Dad, and they have a wealth of practical experience. Yet it puts them in a box does it not, if the doctor and they disagree? And it means that messages get relayed to us second hand. How do we get better care for Mom and Dad?

:- Doug.

There is quite a bit of literature out there looking at the “physician as technician” model of care. It degrades the physician and minimizes their expertise. Unfortunately, the world of medicine is controlled by money, not medicine. So the doctor’s expensive time is only spent on high level issues and the rest is delegated or ignored.

In rural communities, you probably find the old version of family practice and knowing your patients still in place. But most of medicine has become compartmentalized with the doctors barely being able to work with the other physicians on the case. The person is divided into body parts with each technician focused on a certain area. Kinda like a factory. Because of the practice requirements most do not see the big picture, just the organ system in front of them.