It is human nature to avoid thinking about incapacity, sickness and death. Avoiding these difficult topics does not make them go away but instead creates anxiety and fear which rises to the surface from time to time. People with a solid plan to do not feel this anxiety. People who plan have peace of mind and a higher quality of life.

This article contains Amy Hsiao’s Top 10 Rules for getting your parents Aging-ready. Some people are reluctant to discuss these issues but you can use this article as a reason to get the conversation started.

These are not easy or fun discussions to have but without such talks, you will not be sure how to help your parents in the future and you will lack the best tools. You can use this article as an excuse to get the conversation started. Good discussions result in an action list so that important planning opportunities are not lost.

• Ask your parents where they wish to live if they cannot care for themselves.

• Ask whether they have considered how to pay for the care that may be required?

• Ask whether they have considered what health care they wish to be provided if they are in a terminal, vegetative or end-stage condition.

• Ask your parents what they would like you to do to help them if they can no longer make decisions on their own.

• Ask whether they have any insurance that you should know about (i.e., long-term care insurance, catastrophic health care coverage or similar policies).

• Ask where they keep their important papers and whether they would feel comfortable with your having copies of key documents now.

• Explain that you will never meddle but that you care about them and want them to have what they need.

A power of attorney document can allow your parents to pick a person or persons who can step in and do for them if they cannot do for themselves. Even regular powers of attorney can be immensely helpful but, in California, there is special language that can be added to powers of attorney for aging and long-term care issues. Language such as “anything I can do I allow my agent to do” is not enough. Some special power of attorney provisions to consider:

• Specific language authorizing the agent to protect income

• and assets against the cost of long-term care. This means, for example, authorization to take steps to legally protect assets and qualify for Medicaid/Medi-Cal and/or V.A. benefits.

• Specific authorization for the agent(s) to create trusts to protect income (general trust creation provisions are not deemed sufficient by the government);

• Authorization (where desirable) for the agents to gift to themselves

• Authorization to sign admissions agreements for life care facilities without the agent being held liable for payments

• Authorization to apply for health and long-term care insurance benefits and to make claims

• Authorization to apply for government benefits.

Powers of attorney can be a generic form but forms will not take advantage of all that the law has to offer, such as the above. Remember that the power of attorney does not give away any of your parents’ rights. It simply appoints a helper, albeit one with great authority. Your parents retain all rights including the right to revoke the power of attorney while legally competent.

While your parents may be able to legally shelter their assets and qualify for V.A. or Medicaid/Medi-Cal to pay for home care, assisted living and nursing home care if and when they need it, long-term care insurance can still be helpful. Contact a reliable advisor who will show you quotes, terms and ratings from more than one insurer. You may also contact captive agents who sell for only one company but you should then check with others also. Have an Elder Law Attorney review the policy details to make sure you buy what you need. Talk to the agent about a policy for you as well.

Recent studies show that living will forms are often not honored by health care providers. While they may be legally valid, one to two-page living will forms often do not cut it. Vagaries create liability and enforceability problems. It takes much longer just to define the terms. What works best is an integrated package which contains a heath care agent designation, living will and health care power of attorney. Great specificity is desired while also leaving enough discretion to the agent. It is not enough to say AI do not want artificial procedures, without then carefully defining what is meant by that term. Also, it is important that the document deal with such issues as relieving the agent from liability for health care expenses, relieving the doctor of liability so long as the doctors honors the document and considering different procedures or scenarios. Once signed, it is important that the document be accessible when needed. Supply one copy to the primary care physician ahead of time. Make sure each designated agent has a copy. Keep

In most cases, we want our clients to avoid a probate proceeding. Probate is the court process by which a person’s estate is managed and then distributed. Under California law, a probate is necessary if a person passes away with more than $166,250 of assets under his or her name, including the fair market value of real estate (not equity), or if there is a minor beneficiary involved. Probate can therefore often be avoided by placing other persons names on your parent’s assets as beneficiaries or co-owners or through the use of trust agreements or other entities. But beware... trusts, beneficiary designations and especially joint ownership, have significant pros and cons. Consider, for example, what would happen if a joint owner gets sued, divorced or dies. Consider what would happen if the assets that exist now do not exist in the future and how that will affect the division of assets.

Gifts can disqualify people from getting Medicaid/Medi-Cal and other government assistance when they need it. While we can often fix gifts, there are sometimes irrevocable consequences. If your parents wish to gift assets, consult with a qualified Elder Law Attorney to find out how your parents may transfer assets without incurring Medicaid/Medi-Cal gift penalties. The government looks back five years to penalize gifts. In California, the look back period is 2.5 years (30 months).  It may be better to make exempt transfers rather than risk ineligibility later on.

According to Kiplinger’s Magazine, the Wall Street Journal and other sources, aging parents should consider family caregiver agreements as part of their plan for aging. Even from afar, whether planned or not, children end up taking on a multitude of different responsibilities. A family caregiver agreement puts to paper the role each child (or others) will have in taking care of their parents and can even create a plan for compensating the caregivers. Such an agreement can be a great part of an overall aging plan. By setting forth a list of caregiving responsibilities, who is responsible for what and whether and how much compensation or reimbursement is due, family squabbles can be avoided. Courts have ruled that monies transferred pursuant to a family caregiver agreement can be exempt from gift penalties for government benefits. Most Elder Law Attorneys know how to draft these agreements for greatest effect. These agreements are very detailed and usually contain pages of responsibilities and protections. Here are just a few necessary tasks to consider in the Agreement:

• Payment of bills and financial management

• Coordination of home health care

• Receiving and reading mail

• Advocacy with health care providers

• Working with the parents’ lawyer, accountant and/or financial advisor

• Investigating and securing appropriate living arrangements at home, in assisted living facilities and, if necessary, in nursing homes.

• Maintaining or disposing of the home or other real estate

• Coordinating and advocating with insurance

It can be very costly and difficult for a child to step in for a parent if the child does not know where to find everything and what the parent’s wishes are. Do not let the perfect be the enemy of the good. Even if your parents don’t have all of the desired information at the ready, it is best to start the notebook. Consider doing one yourself and showing your parents by example. Here is a list of some of the items to include in the notebook:

• Legal documents including wills, codicils, trusts, amendments to trusts, powers of attorney, health care advance directives (living wills, health care agent designations and health care powers of attorney) and deeds.

• The name and contact information for the financial advisor, accountant and lawyer. A list of life insurance policies

• Pre-need funeral plans

• A photocopy of Medicare and other insurance cards

• A list of assets. This does not have to be a formal accounting but enough information so that the children or other agents can be made aware of and locate accounts, safe deposit boxes and other assets.

• Any special directions about care, assets and wishes.

People wish to remain as independent as possible for as long as possible. Some will say that they never want to move out of their home. In fact, however, most people will find it better or necessary to leave their home at some point in the future. The s statistics are overwhelming. For example, most people state that they will not go into a nursing home but they are plenty full. The goal should be to remain as independent as possible with as high a quality of life as possible. Often, though some do not recognize it yet, a move to an assisted living or independent living community can be affordable and provide greater safety and a better quality of life. Also, some will need nursing home care because that it is the only place to get around -the-clock skilled care. me, a good plan should include finding the best community should it become desired or necessary in the future. Often, the desire or need for a move can happen very quickly. Without a plan, and having to make quick decisions, it is much more difficult to end up in the right community. A good plan includes the following steps:

• Talk to professionals in the community about which independent, assisted living or skilled nursing facilities have the best reputation.

• Depending upon the condition of your parents, tour independent, assisted living or skilled nursing facilities now, in advance of need.

• If your parents are staying in their own home for now, examine ways of preventing falls and making the home safer and more aging-friendly. Consider personal emergency response systems.

• Make yourself aware of social service agencies and care management resources now, in advance of emergencies. Consider consulting with a geriatric care manager or aging life care professional. Find one at aginglifecare.org, the website for the leading geriatric care manager association.