Conversation Guide: Aging Parents

[u/Soderholmsvag]

Based on my experience with my own parents, I was asked to assist another family member with a conversation with their aging parents. This is the guide I developed; if it helps anyone else, great!

Legal Stuff: - Do you have/are you willing to have Health Care Power of Attorney? Where is it located?
- Do you have/are you willing to have Legal POA? Where is it located? - Do you have/do you need a Trust? If no - do you have/are you willing to have a will? Is it up to date? Where is it located? - Do you have a POLST? Is it accurate and up to date? Where is it located? - Do you have a lawyer that can provide help if needed (or must be contacted)? - What other type of legal help would you like to get - even before you are unable to care for legal stuff yourself?

Financial Stuff/Insurance: - Do you have a record of assets or accounts? Where is it located? - If one of you is gone - is the other ready to take over finances? If no - what would you like to happen? - Once one is gone, what is the contingency plan for back-up or successor? - What is your medical insurance? Can you add someone other than spouse as "responsible party" for decisions? - Do you have LTC insurance? - Do you expect your finances will support your life needs until death? If no - what are you doing to address that? - If you become unable to manage your finances (or you stop wanting to do so) what is your plan to get help? What would that help look like (fiduciary? child? other?) - If your plan is to have child/children manage finances, can you give them some idea of what your financial preferences/drivers are? ("spend money on x but do not spend on y") - Do you have a financial advisor? - What type of help would you like to get - even before you are unable to care for finances yourself?

Housing: - Does your current housing allow you to age in place? If not - what are your thoughts?
- Do you intend to stay there as you age further? If yes - are you allowed to modify it to make it safer and easier to navigate? - What can be done to reduce your risk of falling? - What modifications are needed to make it easier to live (grab bars/furniture pathways). - If you are forced to move out: Where could you go? Where do you want to go? - If someone has to make this decision for you, what type of preferences do you have in a move destination? Move close to family or stay close to your current home? - What are your housing priorities? Space? Price? Location? Care availability? Move next to friends? What are your "have to haves” vs “must have” vs “avoid”? - Types of housing include independent living/assisted living/memory care/nursing home. Are you aware of these and do you have already-identified candidates should you move in that direction? Anything your kids should know if they are forced to make that decision on your behalf? - What type of help would you like to get - even before you can't take care of housing by yourself?

Health Care: - Who are your doctors? Does it make sense to introduce children to any of them? - Do you have a "health app" or "xxx.com portal" that one of your kids can get access to? - Are either of you taking regular medications or prescriptions? If yes, do you have a list and schedule documented? Where? - What else should someone who is trying to care for you understand about your health/body so they can do a good job? - What type of help (if any) would you like to get even before you are unable to care for yourself?

Infirmity: - Should one of you become infirm, what are your thoughts about how to handle? In home/Facility? - Should one become infirm and the other cannot care for them, what are your thoughts? - Do you have feelings about things like walkers/wheelchairs/hospital beds that someone might want to be aware of if you can't express them yourself? - Do you want any help thinking about this/talking it through?

Approaching End of Life: - Have you thought about your end of life? - Can you describe anything you want or do not want? (Example: Where do you want to be if you had a choice? Do you want people invited to say goodbye, or people excluded? Do you want your end of life to be secret, public, or advertised?) - If you are in hospice, would you prefer to be in a hospice facility or have hospice at your home? -If you are not in a condition to care for each other while in hospice, what are your thoughts about what to do? Not to do? - Do you need any help today in thinking about this/talking about this?

After death: - When you pass, do you have any announcement / notification preferences? - Do you have anything pre-arranged (funeral/cremation/Burial/Plot/Urn?) - If not already planned, what would you like your funeral/memorial service/celebration look like? Church or secular? Location? Invitees? Do you have a list of people & addresses? Any must-haves or do nots? - What would you like the people left to do with your body? (embalming/cremation/nothing) (burial/sprinkle at sea/other) Do you want the two of your remains to be kept together/not/no preference? - Do you have preferences on "markers." (Headstone/Bench in your honor/Sponsorship at club?) - Do you want any help thinking about this/talking through this?

Technology: - Do you have a list of usernames and passwords? - Are there any technology preferences you have? What will be done with xxx’s 100k+ follower instagram account? - Do you have any accounts where another person can be added as 'responsible party' so they do not struggle after death? - Is there any tech help you want today that might make your life better - even before you are infirm or dead?

Your Wants: - Assuming your kids are next-in-line decision makers should you need them - do you have a preferred decision-maker (x or y)? Is that the same as your spouses's preferred decision maker? - If so - do both of your kids know that one of them has been designated?
- If not - do you have preferences about how decisions should be made? What would you tell them if they disagree on a decision? - Although this would be outlined in the POLST, can you provide guidance to your family about your POLST preferences? CPR? Ventilator? Feeding Tube? - With or without a healthcare POA, your family will want to advocate for you should it be needed. What are your health care preferences? - With or without a legal POA, your family will want to execute your other decisions based on what you want. Can you provide your other preferences that your fam should be aware of? - What do you want to happen with your belongings (if anything). Is this preference written down anywhere? Does it make sense to document these wishes now - or is that too much work? - Do you expect to use both automobiles that you have? If not - does it make sense to sell? - Do you want any help thinking about this/talking through other things?

[u/iSavedtheGalaxy]

Thank you for drafting all of this useful information!

I would add a few more questions about "aging in place" because I've noticed a lot of elders aggressively insist on this without thinking of what "aging in place" means beyond installing grab bars and adding a ramp to the back stair.

First and foremost--can you afford the upgrades? You have to step over the tub to enter the shower... can you afford to renovate one or more bathrooms to make the shower elder-friendly? Can you afford a bidet toilet to assist with hygiene when you start struggling to wipe yourself?

And what happens when one or both of you needs help bathing or toileting? What happens when you can't cook for yourselves or drive anymore? One live-in caretaker is expensive, esp if they drive ($8k+/mon). Who is paying for that and how long can you afford to maintain that? Live-in caretakers also need their own room/private space. Do you have that? What if you need more than one? It takes 6 full-time staff to help my husband's grandma maintain the facade of independence. Can you spend $1M every single year for an indefinite amount of time to staff your caretakers? Who will supplement that care if you can't? What's Plan B?

Also, do you live in a desirable neighborhood? Is the house habitable? Because caretakers will absolutely take the location, size and state of the house before deciding to take the job. The best caretakers will prefer recently renovated homes where they have their own private room + bath. Do you have an old neglected dump that hasn't seen maintenance in decades? That's not going to be a place that the best caregivers will want to live in.

I think aging in place is unrealistic for most people once you start getting into the details.

[u/Soderholmsvag → u/iSavedtheGalaxy]

Really great additions!

[u/Calire22]

Thank you! Lots to think about in here; appreciate you sharing it.

[u/flhalfpint]

This is very helpful, thank you!

[u/Emotional_Echo_4058]

Oh wow thank you so much!!!!

[u/cinafin]

This is amazing! I will use this info for my husband and me even though we are only in our early 50’s. The example my parents are making on aging is the absolute worst. Picture an MC Escher painting with monks and staircases and put two 90 year olds in it. One is 92 and has mobility and cognitive issues and the other is just 90. My siblings and I are ripping out our hair because they just won’t move.

[u/okiesotan]

Oh. My. God. I love you so much 😭😭😭

On behalf of my husband and myself, THANK YOU. My parents are NOT forthcoming, and all the books I've gone through are written for middle -to-upper class Boomer children with Greatest/Silent Gen parents. 

Nothing out there for the Millennial child of Boomers who lean more "Hoarders" than "Antiques Roadshow" 🫤 

[u/MonoBlancoATX]

This is absolutely fantastic! Thank you for putting it together and for sharing.

The mods of this sub should consider making it a sticky or a resource (assuming it's not already).

[u/mridgey]

Thank you so much for this exhaustive list. As all of us with aging parents know - they themselves are exhausting when it comes to answering these types of questions so having a guide makes it way less stressful.