Blog Series Part 7: Medicaid Application Denials

By | Elder Law, Estate Planning

The complex nature of the Medicaid application process can lead to more “denials” than one would expect.  The obvious assumption is that most applications are denied because the applicant is financially ineligible or improperly gifted assets.  However, there are a number of other reasons why an application may be denied.  This post will discuss some of the potential (and easily avoidable) causes of denial and what to do if it happens to you.

Missing Information – One of the most common reasons for the flat-out denial of a Medicaid application is the applicant simply failing to send in the supplementary documentation requested by the assigned caseworker.  Over my years working as a nursing home administrator and then later in my elder law practice, I saw countless deserving, otherwise eligible Medicaid applicants receive denial notices because they failed to respond in a timely fashion to requests for copies of additional documentation.  The easiest way to ensure your application is properly processed by your local Department of Public Welfare County Assistance Office (“CAO”) office is simply to give them WHAT they ask for, WHEN they want it.

Within a few weeks of submitting your application, the first thing you will receive is a notice assigning a caseworker to your application and letting you know the additional information that the caseworker will need to make a determination.  The notice also provides a date by which you need to submit the documents.  Do NOT disregard this date.  As the process continues, you repeatedly may be asked to submit more clarifying documentation, with a new deadline applied each time.  Keep in touch with your caseworker and if you are having trouble getting your hands on old or lost documentation, make sure they know that and ask for an extension of time.  Failing to send in exactly what is requested basically guarantees your application will be denied.

                  Ineffective Caseworker – While pointing this out won’t earn me any bonus points with the Department, the truth is that not all CAO caseworkers are created equal.  For every caseworker who knows the rules inside and out and cares deeply about her job, there is another case worker who is just learning the rules and is completely overwhelmed by her caseload.  Unlike the customer, the caseworker is NOT always right.  If you find that your application is being unexpectedly denied and you don’t agree with the caseworker’s interpretation of the law or the facts, politely point them in the right direction.  Argue your side, ask for contact information for the supervisor and get her or him involved.  Work your way up the chain.  Elder law attorneys do this exact thing for their clients all the time and often have the direct emails and phone numbers for every supervisor at the DPW offices in their region.  Do not simply accept “No” for an answer if you feel a mistake has been made.

Lying To Your Caseworker – This will be a short one – simply don’t do it.  Don’t try to hide assets or hide transfers.  If you made a transfer within the past 5 years, before you even submit the application you should be prepared to disclose it and have a plan for handling it, including setting forth the applicable calculation of any ineligibility period. Try to make it as easy as possible for the caseworker – don’t treat it as an adversarial relationship.

The Appeals Process – When a final determination of ineligibility has been issued, the applicant has 30 days from that date to request a fair hearing to appeal the decision.  An appeal form is typically provided on the reverse side of the determination notice.  The CAO first must offer the appellant an opportunity to have an informal conference in the hopes you can resolve the issue prior to the hearing.  ALWAYS take advantage of this excellent opportunity for informal communication, if only because it gives you more information on the agency’s arguments prior to the hearing.

Should your case not be resolved prior to the hearing, you or a representative will have the opportunity to present evidence and call witnesses at the hearing arguing your case, including cross-examining the CAO’s witnesses.  Final determinations are made by Hearing Officers who are DPW officials.  Their role is to conduct the hearing in an orderly, but informal manner, obtain relevant testimony and render a decision based on facts and evidence as applied to the State’s regulations.  Federal regulations require the Department to issue a Final Administrative Action Order within 90 days of that hearing. If the final order remains unfavorable to the applicant, there is still one more chance to apply for further reconsideration by the Secretary of DPW.

The bottom line is that even if you have made some of the mistakes listed earlier in the article, the appeals process offers several opportunities, both formal and informal, to correct the situation.  One must remember that there are always opportunities to settle if you remain open to discussing your case and continue attempting to resolve the issues under appeal.

This blog post was originally created by Joellen Meckley while she served in an “Of Counsel” position in our firm. While she no longer does that, we do maintain a  professional relationship and if you have any Elder Law needs, I’d recommend you reach out to her firm Meckley Law. If you need Estate Planning, please reach out to us.


Blog Series Part 6: Community Spouse Planning

By | Elder Law, Estate Planning

Over the past few weeks this blog series has discussed many of the complex and varying rules that apply to obtaining Medicaid coverage for nursing home care.  Today’s post will hone in on one particularly complicated application scenario – when one spouse requires nursing home care, but the other spouse is healthy enough to continue living in the community.  Such situations offer several opportunities for financial planning, even after one spouse has already been admitted to the nursing home.  However, costly mistakes can occur if the financial strategies are approached without the advice of a knowledgeable elder law attorney.

The Basic Rules:

  • Federal and State law provides certain protections for a Medicaid applicant’s spouse who continues to live in the community (the “community spouse”). Those protections are designed to prevent the community spouse from total impoverishment.
  • The first protection is the “community spouse resource allowance” or CSRA. The State considers certain assets to be exempt from the Medicaid spend down process.  Examples of some of those assets are:  the couple’s residence, household goods and furniture, one vehicle, the community spouse’s IRA and several other items.  However, other assets are deemed NOT exempt from spend down, including checking and savings accounts, mutual funds, CD’s, and certain other financial resources.  Of the assets that are deemed “non-exempt,” the community spouse is permitted to keep ½, up to a maximum of $119,220 in 2015.  The remainder of the assets must be spent down by the institutionalized spouse before he or she can obtain Medicaid coverage.
  • The second protection afforded by law for the community spouse is something called the “monthly maintenance needs allowances” or MMNA.  As a general rule in Pennsylvania, the community spouse is permitted to retain income which is in his or her own name, instead of putting that money toward their spouse’s nursing home care.  However, in situations where the community spouse’s individual income is below a certain amount, a formula incorporating “shelter costs” such as mortgage and utilities expenses is calculated to determine an amount of additional income that will be allowed to that community spouse.  This MMNA can range from $1,992 to $2,980.50 (in 2015).  If it is determined that the community spouse’s income falls below their calculated MMNA, then income can either be shifted from the institutionalized spouse to the community spouse to bring their income up to the MMNA, or the couple’s non-exempt assets can actually be converted to an additional source of income for the community spouse.

Planning Opportunities

The most common financial planning strategy for the community spouse is to convert joint assets into a source of income.  Generally this is done by taking assets and using them to purchase a Medicaid compliant annuity in the name of the community spouse.  Bear in mind that the use of annuities in Medicaid planning is a frequently-changing area of law and should not be attempted without the advice of an elder law attorney.  Another common planning option is to use non-exempt assets to purchase exempt assets.  For example, non-exempt assets could be used to make home repairs, pay off a mortgage, purchase a new car, or create a prepaid funeral account, just to list a few examples.  Many people rush into making such purchases in anticipation of one spouse needing nursing home care thinking that it will help that spouse qualify more quickly.  What they often don’t realize is that they may be better off waiting to purchase non-exempt assets until one spouse has already been institutionalized.  The “snapshot” of assets used to determine the community spouse’s resource allowance isn’t taken until the other spouse has been admitted.  So, if assets are prematurely depleted prior to admission, it may result in the community spouse’s calculated resource allowance being lower than it would have been had the couple retained those assets up until they were actually admitted to the facility.

Proceeding with any of the above strategies can be treacherous without the advice of an elder law attorney who has specific knowledge about current Medicaid law.  The bottom line is that paying for nursing home care has become very complex, but solutions exist if you know the right questions to ask and plan accordingly.

This blog post was originally created by Joellen Meckley while she served in an “Of Counsel” position in our firm. While she no longer does that, we do maintain a  professional relationship and if you have any Elder Law needs, I’d recommend you reach out to her firm Meckley Law. If you need Estate Planning, please reach out to us.

Blog Series Part 5: Medicaid Asset Protection Strategies

By | Elder Law, Estate Planning

In Parts 1 through 4 of this blog series, I discussed the different ways of paying for long term care in Pennsylvania and how Medicaid has grown to become the most common payment method.  Medicaid functions as a government safety net for those who require 24-hour care in a nursing home and whose income and assets are insufficient to pay privately for that care.  In order to qualify for Medicaid to pay for nursing facility services, your income and assets must fall below a certain threshold established by the State’s Medicaid rule (described in detail in Part 2 of this series).

Senior citizens have many different reasons for wanting to preserve their assets instead of seeing them spent down to qualify for Medicaid.  Perhaps they are concerned about the financial resources of their spouse who remains in good health and continues to in the community.  Or, perhaps they wish to leave a modest inheritance for their children.  Whatever the reason, with proper advance planning, it is possible to protect your assets from the costs of nursing home care.  Obviously, the earlier you take steps to preserve assets, the more assets you should be able to protect.  However, even if you have already been admitted to a nursing facility, there are some limited options available which will leave you better off that you would be had you  performed no planning whatsoever.

Advanced Planning Strategies

As discussed in Part 4 of this blog series, Medicaid applicants are required to disclose any gifts or transfers of assets they have made in the 5 years preceding their application and are penalized if those transfers are deemed to have been made in exchange for less than fair market value.  Thus, to best protect your assets, you need to plan at least 5 years in advance of needing long term care.

Medicaid Asset Protection Trust – This planning option requires the future Medicaid applicant to place his or her assets, including real estate and investments, into an irrevocable grantor trust.  The trust can be structured in whatever way makes the most sense give the settlor’s unique financial situation and needs.  The most important aspect of this plan is that it be designed to enable the person to pay privately for at least 5 years of nursing home care following the creation of the trust.  One benefit to such a trust is the fact that trust beneficiaries do not gain ownership over the trust assets until the trust’s settlor is deceased.  This makes it more desirable than outrights gifts to family members due to its protection from the beneficiary’s creditors.

Gifting, Coupled with Long Term Care Insurance or Retained Assets – For seniors who are fortunate enough to have enough income to live comfortably on that alone, another option is to simply gift away the bulk of their assets to their family members, providing them with an “early inheritance.”  However, the senior must still plan for the possibility that he or she may unexpectedly require long term care at some point in the 5 years immediately following the gift.  Thus, either enough assets must be retained to supplement the person’s income should they need to pay privately for long term care for some period of time, or, they also need to use some of their assets to purchase a long term care insurance policy prior to gifting the remainder of their money away. The plan would be to determine some combination of income, insurance, and assets which could cover the costs of nursing home care for at least 5 years, should the need arise.

While it may be tempting to simply gift all of your money to your children assuming that you can trust them to not spend it right away and use it to pay for your nursing home care should the need arise, this tactic is highly risky and ill-advised in nearly every situation.

Late Stage Planning Strategies

While the best way to protect significant assets from going to the nursing home is to plan well in advance, the truth is that most clients fail to do that for many different reasons.  However, reviewing your specific situation with an elder law attorney who is knowledgeable about Medicaid planning should at least help you optimize your situation.

Married Applicants – Those with spouses in the community have the most options available to them to preserve assets in late stage planning.  One option is to covert excess assets to income for the community spouse by purchasing a specific type of annuity called a “DRA compliant annuity”.    Another option is to use at-risk assets to pay down all debts, make home improvements, or purchase assets which are not counted by Medicaid, such as a more expensive home which is placed in the name of the community spouse, a new car, or purchase pre-paid funeral contracts or other necessary personal items.  Money spent on disregarded assets is an easy way to decrease the assets which will be considered in determining Medicaid eligibility.

Unmarried Applicants – In the case of an unmarried Medicaid applicant, there are still a few ways to protect limited assets from going to the nursing home, even after the individual has already been admitted.  Assets can be used to purchase pre-paid funeral arrangements and other necessary personal items such as hearing aids, glasses, clothing and other items that they’ll need in the nursing facility.  While these items don’t preserve significant assets, they at least protect some money.  In the case where a single person has more assets than can be depleted quickly, but still wishes to immediately qualify for Medicaid, one way to potentially preserve some assets for family members is to convert all available assets into a DRA-compliant annuity that pays income.  That income together with Medicaid then pays for the person’s long term care.  One of many requirements for such an annuity is that the State be named the remainder beneficiary of the annuity.  In this case, after the purchaser’s death, the State will make a claim against whatever principal is left in the annuity to be reimbursed for the funds paid by the Medicaid program for the person’s nursing facility care.  If after receiving that reimbursement there are still funds remaining in the annuity, those funds can be dispersed to the purchaser’s named beneficiaries.  While it is not a guaranteed method of transferring an inheritance to your family, there is certainly no risk in trying it if you’ve missed other opportunities to conduct advanced planning.

The laws, rules, and legal cases applying to Medicaid are constantly changing.  For that reason, none of the above listed asset protection strategies should be attempted without first consulting an elder law attorney who is up-to-date and knowledgeable on such techniques and the current state of the law.

This blog post was originally created by Joellen Meckley while she served in an “Of Counsel” position in our firm. While she no longer does that, we do maintain a  professional relationship and if you have any Elder Law needs, I’d recommend you reach out to her firm Meckley Law. If you need Estate Planning, please reach out to us.


Blog Series Part 4: Five-Year Look Back Period

By | Elder Law, Estate Planning

One of the most frequently misunderstood aspects of the Medicaid qualifying process is the “five-year look back period.”  In a nutshell, at the time a nursing home resident submits an application for Medicaid, not only are the applicant’s current income and assets evaluated for eligibility, but also any gifts or transfers of assets the applicant made within the past 5 years are evaluated for whether or not those gifts or transfers were made in contemplation of needing nursing home care and/or if fair market value was received in return.

For obvious reasons, this question is asked of applicants because it is the State’s desire to discourage people from giving away their money or assets in order to avoid “losing them to the nursing home.”  In actuality, my experience has found that most people are not strategically giving away their assets or money in order to shield them from the nursing home.  Instead, much more commonly, people very innocently make gifts or transfer assets to family members, never dreaming that they may need nursing home care in the next 5 years.

When the State determines that such a gift or transfer has occurred, if the applicant is otherwise eligible for Medicaid in all other ways, then a penalty period will be applied before the applicants Medicaid benefits kick in.  What this means in practice is that someone who has already spent down his or her assets and has no available funds to pay privately for a nursing home still may incur a lengthy penalty period before they can receive Medicaid benefits.  This penalty period can be absolutely devastating for both the applicant and their families and is frequently a source of litigation.

Despite the fact that the law states that gifts made with a purpose other than qualifying for Medicaid won’t be penalized, the reality of the application process is that at the local office where your application is being processed, caseworkers often routinely apply penalty periods to applicants who have made such gifts or transfers regardless of the stated purpose, forcing the applicant into a lengthy and complicated appeals process.

So what might constitute a potentially disqualifying gift or transfer in the eyes of the Medicaid program?  One example that receives close scrutiny is cash gifts in excess of $500.  This even includes routine tax-free gifts made to family members that fall within the IRS annual exclusion amount.  People often assume that because the gift is tax exempt and doesn’t need to be reported to the federal government, that it’s also allowed under Medicaid law.  Unfortunately, that isn’t the case.  Similarly, adding your child’s name to your bank account or to the deed to your house, without receiving anything in return from the child, also constitutes a potentially disqualifying transfer.  In fact, even if you do receive compensation in exchange for a transfer of assets, if it is determined that you received less than fair market value, you could be penalized.  Simply put, it is a complicated rule that trips up many otherwise deserving applicants, many of whom have no other option for paying for long term care.

Your best bet is to tread carefully when making financial decisions if you suspect there is any chance you may require long term care in the next few years.  It’s also a prudent decision to consult with a qualified elder law attorney who can help you in planning for long term care and applying for Medicaid benefits, should the need arise.

This blog post was originally created by Joellen Meckley while she served in an “Of Counsel” position in our firm. While she no longer does that, we do maintain a  professional relationship and if you have any Elder Law needs, I’d recommend you reach out to her firm Meckley Law. If you need Estate Planning, please reach out to us.


Blog Series Part 3: Medicaid Application Process

By | Elder Law, Estate Planning

When a client walks into my office seeking advice on how to obtain Medicaid benefits for long term care, they typically have just learned that their loved one’s Medicare skilled nursing benefits are about to be terminated and the nursing home simply gave them a blank Medicaid application to complete with no other guidance.  However, an elder law attorney experienced with Medicaid planning should be able to guide you through the process easily from beginning to end.

The application form is called the PA 600L and can be found online or obtained from the nursing home’s business office.  It has 15 sections, each requiring different types of supplementary verification documentation, but not every section applies to every applicant.  The first required document is something called the MA 51 Options Assessment, which is simply a confirmation that the applicant requires long term nursing care, completed by the nursing home.

The next step is to begin gathering all of the documents required to prove the information listed in the application itself.  This includes paper verification of the applicant’s identity including proof of birth like a driver’s license or birth certificate, and a social security card.  It also includes documentation related to the applicant’s current health insurance coverage and health care costs, such as copies of insurance ID cards and recent medical bills.  If the applicant still owns a home or other assets such as insurance policies, a vehicle, or investments, then supporting documentation like deeds, mortgages, burial plots and account statements are required.  Proof of all income also must be provided, such as that year’s Social Security statement or documentation of all other income such as pensions or annuities.

Often, the most overwhelming part of the application is the section requesting statements of all bank and investment accounts that the applicant has owned in the last 5 years.  Most people are shocked to find out that the state truly will review financial transactions going back that far looking for unauthorized transfers.  If the applicant has a spouse remaining in the community, there is yet another layer of required documentation related to the spouse’s financial situation.  It is not uncommon to submit a stack of supplementary paperwork with the application that is well over an inch thick.

The application may be submitted up to 90 days after the date on which benefits are requested to begin.  The approval process itself can take several weeks and often includes multiple follow-ups with the assigned caseworker, who often requests additional information to complete their review.  It can be a long, arduous process, however, an effective elder law attorney should be able to assist you in pulling together an application which has a greater likelihood of being approved quickly by avoiding commonly made mistakes and pitfalls.

This blog post was originally created by Joellen Meckley while she served in an “Of Counsel” position in our firm. While she no longer does that, we do maintain a  professional relationship and if you have any Elder Law needs, I’d recommend you reach out to her firm Meckley Law. If you need Estate Planning, please reach out to us.


Blog Series Part 2: Medicaid and Long Term Care 101

By | Elder Law, Estate Planning

In Part 1 of this series, we described the most common ways to pay for long term care in a nursing home, namely long term care insurance, personal income/savings, and Medicaid.  According to a policy brief published by the University of Pittsburgh in 2013*, the Pennsylvania Medicaid (or Medical Assistance) program currently carries the burden of 65% of the total cost of nursing home care provide in the state.  Each state administers its own Medicaid program and has its own unique eligibility rules in order to qualify.  The basic eligibility guidelines for Pennsylvania (in 2015) are described below:

  • A person must meet ALL financial and non-financial eligibility requirements in order to obtain Medicaid benefits for nursing home care.
  • The 4 basic Non-Financial Eligibility Requirements are: 1) A doctor must complete a form attesting to the fact that you have a medical need for long term care, 2) You must be a U.S. citizen or a qualified non-citizen, 3) You must be a resident of Pennsylvania, and 4) You must have a Social Security number.
  • Financial Eligibility is based on an analysis of two things: Income and Resources.  In a nutshell, if BOTH your income AND resources fall below a certain threshold, and you meet the all of the other applicable eligibility criteria, then Medicaid will cover the cost of nursing home care above and beyond what you can pay on your own.
  • How is income counted?
    • Most income is counted, including Social Security, pensions, investment income, IRA withdrawals, etc.
    • Income Limits: For a single person, if your monthly income is below 300% of the Federal Benefit Rate you are automatically income qualified.  Currently, that amount is $2,163/month.  If your monthly income is higher than that, you may still be considered Medicaid eligible if your medical expenses offset your income to bring it down to a limit of $2,550 (currently).  Many people with higher incomes are still able to qualify for Medicaid because the cost of care in a nursing home is considered a deductible medical expense, thus bringing them below the income eligibility threshold.  Different rules apply for married applicants, which will be discussed in a later blog post.
  • How are resources counted?
    • Examples of resources counted for eligibility purposes include bank accounts, stocks, IRA accounts, vacation property, and the cash value of life insurance. Examples of resources which are NOT counted include the value of your home if it is less than a certain amount and you intend to return home or your spouse lives there, one motor vehicle, all burial spaces/plots, and burial reserves subject to specified limits.
    • Resource Limits: If your income is $2,163/month or lower, you currently are allowed to retain up to $8,000 in resources.  If your income is higher than $2,163 (regardless of medical expenses), you are only permitted to retain $2,400 in resources.  Many people pay privately for long term care until their resources fall below the limits, and then apply for Medicaid.
    • The Look-Back Period – At the time you apply for Medicaid you must report any assets that you transferred, sold or gave away within the past 5 years/60 months. If the Department of Public Welfare determines that you gave that asset away for less than Fair Market Value, your application may still be approved, but a “penalty period” will be assessed before your benefits can begin.  This can be devastating to both the applicant and/or their family because often times the asset which was given away is now depleted or unavailable, leaving no cash to cover the private cost of nursing home care until the penalty period ends.

How the Medicaid application process works for married applicants will be discussed in subsequent posts in this series, as well as how to preserve assets without running afoul of the Look-Back Period.  If you would like more information in the meantime, contact Yardley Estate Planning, LLC where you can come in for an elder care consultation, explore your options and develop a prudent plan for paying for care.

This blog post was originally created by Joellen Meckley while she served in an “Of Counsel” position in our firm. While she no longer does that, we do maintain a  professional relationship and if you have any Elder Law needs, I’d recommend you reach out to her firm Meckley Law. If you need Estate Planning, please reach out to us.

Blog Series Part 1: Paying for Long Term Care in Pennsylvania

By | Elder Law, Estate Planning

Part 1 – Three Options for Paying for Nursing Home Care

The average annual cost of care in nursing home in Pennsylvania is currently a little over $100,000/year. It is no wonder that a common fear among older adults is that they will end up in a nursing home and leave their spouse in the community destitute or pass away without any inheritance to leave for their children. Knowledge is power in any situation, so the first thing one needs to understand in this situation are the basic options available to pay for nursing home care.

First, to dispel a misconception, Medicare Part A (not to be confused with Medicaid) does NOT pay for long term custodial care in a nursing facility. Medicare will partially cover the cost of up to 100 days of skilled nursing care and rehabilitation, if the recipient meets certain strict eligibility criteria. But note, Medicare never pays exclusively for what is called “custodial care,” like help with bathing, dressing, or caring for oneself.

So what are the basic options for paying for long term care in a nursing home? One option is Long Term Care Insurance, if you are fortunate enough to have a policy in place. However, many individuals did not have the foresight or could not afford to purchase a policy when they were younger and premiums were more reasonable, thus few people can rely on this payment option. Another option for covering the cost of long term care is the most obvious one – using a combination of income and a gradual liquidation of your assets to the cover the cost of care. While this is certainly a straightforward approach, at a cost of approximately $100,000 a year, most people will quickly deplete whatever assets they own. If the nursing home resident is married with a spouse living in the community, this option is particularly devastating due to the rules dictating what assets may be retained by the community spouse versus which must be used to pay for the institutionalized spouse’s care.

Last is the Medicaid program, also known as Medical Assistance in Pennsylvania. Medicaid is the fundamental financial safety net for most individuals facing long term care in a nursing home. While the availability of Medicaid is a godsend for many needing care, it also has very complex set of financial qualification rules and the potential pitfalls are numerous, especially for those with a community spouse or those who were lucky enough to have certain assets prior to entering the nursing home. Many try to take steps to try to protect those assets without consulting with an elder law attorney knowledgeable about Medicaid Planning, which if done incorrectly could result in a denial of benefits and stiff financial penalties.

Subsequent parts of this Blog Series will focus primarily on how the Medicaid application works, how to submit a successful application, and the potential planning options available to protect and preserve your assets for loved ones so it’s not all lost to the nursing home. If you would like more information in the meantime, contact Yardley Estate Planning, LLC where you can come in for an elder care consultation, explore your options and develop a prudent plan for paying for care.

This blog post was originally created by Joellen Meckley while she served in an “Of Counsel” position in our firm. While she no longer does that, we do maintain a  professional relationship and if you have any Elder Law needs, I’d recommend you reach out to her firm Meckley Law. If you need Estate Planning, please reach out to us.

Ask an Elder Law Attorney – What can I do if my elderly parent is losing the ability to make decisions and manage his or her affairs?

By | Elder Law, Estate Planning | 2 Comments

Ask an Elder Law Attorney – What can I do if my elderly parent is losing the ability to make decisions and manage his or her affairs?

By Joellen Meckley, Esq.

Here are three things you should keep in mind:

  1. The best time to plan is now. Oftentimes, mental decline in old age does not happen suddenly, it happens gradually. The signs can begin to show in subtle ways, such a noticing your mother isn’t paying her bills or has bounced a check or noticing that your father’s personal hygiene has begun to decline. Don’t ignore those signs, because the best time to plan is when your parent is still relatively healthy and competent. Planning can always be done, but the longer you wait, options become more limited.


  1. These conversations are often difficult. Older adults are no different from the rest of us – some are more resistant to change than others and it can be difficult to raise this subject. If you as a child are worried that your relationship with your parent may be damaged by raising these issues, a subtle approach may work best. Consider relating what a friend is going through with her own elderly parents and use that as a spring board to raise the issue of how you’re worried about what to do if it ever happens to them. Many elderly parents don’t want their children to feel burdened and will be more motivated to address certain issues if they see the potential negative impact their problems could have on their adult child. If there are siblings involved, try to reach a consensus beforehand. A united front can be more effective.


  1. A range of options are available based on existing mental capacity.   Depending on how receptive the parent is, the first step is generally to meet with an elder law attorney who can lay out the options. Hopefully the parent still has some capacity in decision-making and can dictate what he or she wants. They can then be walked through the process of appointing financial and health care powers of attorney, which saves the process of going through court to have a legal guardian appointed. An elder law attorney also can lay out common techniques that can be employed or pitfalls to be avoided when managing the affairs of an aging parent, as well as putting you in contact with a wide range of support resources in the community who are available to help in such a situation such as geriatric care managers, home health agencies, and daily money managers.


Throughout the process, don’t forget that remaining as independent and autonomous as possible may be critical to your elderly parent’s long term well-being and happiness. Obviously, safety and independence must be balanced and decline often continues. However, taking the time to recognize their dignity and promoting independence whenever possible can go a long way in sustaining their quality of life into the future.