Caring for an aging parent: a starter guide
Caregiving often starts with a fall, a hospital stay or a worrying phone call, and families end up making big decisions in a rush. Working through these steps early, before help is urgent, gives your parent more say and gives you more options.
Start the conversation early
Talk with your parent while things are calm. Ask what matters most to them, where they want to live as they age, whom they trust to make decisions if they can’t, and what worries them. Listen more than you advise, because plans made with a parent hold up far better than plans made for one.
Bring siblings and other close relatives in early, and agree on who will handle what, from paying bills to driving to appointments. Write the plan down and revisit it whenever health or circumstances change.
Assess what help is needed
Professionals gauge independence through activities of daily living: bathing, dressing, eating, toileting, transferring (moving from a bed to a chair, for example) and continence. Instrumental activities, like managing money, medications, meals, housework and transportation, often slip first.
Note specific changes and when they began, such as unpaid bills, spoiled food, missed doses or new bruises. Ask your parent’s doctor for an assessment, or hire a geriatric care manager for a fuller review. Many long-term care insurance policies require that someone need help with at least two daily activities, or have a severe cognitive impairment, before benefits start.
Make the home safer
Falls are a leading cause of injury for older adults, and many can be prevented. Walk through the home with your parent, not just for them, and fix the easy problems first.
- Remove loose rugs, cords and clutter from walkways.
- Install grab bars by the toilet and in the tub or shower.
- Add bright lighting, night lights and railings on both sides of stairs.
- Keep everyday items within easy reach, so no step stool is needed.
- Ask the doctor about medications that cause dizziness, and schedule vision checks.
Coordinate medical care
Keep one current list of every medication, including over-the-counter drugs and supplements, with doses, times and the prescribing doctor. Use one pharmacy where possible, so its system can catch interactions between prescriptions from different doctors.
With your parent’s permission, go to important appointments, bring the list and write down instructions. Providers may share some information with family members involved in a patient’s care, but a signed HIPAA authorization removes doubt. Ask about proxy access to the patient portal so you can see results and message the care team.
Put legal and financial documents in place
These documents must be signed while your parent has the mental capacity to understand them. Without them, a family may need to ask a court to appoint a guardian or conservator, which is slow, costly and public.
Rules and form names differ by state. An elder law attorney can draft documents that work in your parent’s state and help plan for the cost of long-term care.
- A durable power of attorney for managing money and property.
- A health care proxy naming someone to make medical decisions.
- A HIPAA authorization so providers can talk with chosen family members.
- A will, plus updated beneficiaries on accounts and insurance policies.
Work out how care will be paid for
Medicare generally doesn’t cover long-term custodial care, meaning ongoing help with daily activities. It covers medical care, plus limited skilled care after a hospital stay or at home under specific conditions. Plan as if most long-term help will be paid privately unless another program applies.
Medicaid may cover nursing home care and, in many states, care at home or in the community, depending on income, assets and state rules. In most states, it reviews gifts and transfers made in the five years before an application for nursing home coverage. Long-term care insurance, if your parent has it, comes with its own benefit triggers and waiting periods. Eligible veterans and surviving spouses may qualify for VA benefits, such as the Aid and Attendance pension supplement or VA home care programs.
Compare care options and plan for respite
Care usually escalates in stages: in-home aides for a few hours a week, adult day programs that offer supervision and activities, assisted living for housing with help, and nursing homes for round-the-clock nursing. Visit in person, ask about staffing and turnover, and for nursing homes, check inspection results and ratings in Medicare’s Care Compare tool.
Caregivers burn out when they try to do everything alone. Your parent’s local Area Agency on Aging, which you can find through the Eldercare Locator, can point you to respite care, caregiver support programs and benefits help. The Family and Medical Leave Act lets eligible employees of covered employers take up to 12 weeks of unpaid, job-protected leave a year to care for a parent with a serious health condition.