As caregivers, no amount of preparation can be too much.  There are many issues that arise and need to be addressed that are not always anticipated when preparing to take on the responsibility of caring for an aging family member.  While it can become suddenly too late, it is never too early to talk to your parent or older family member about the future.  Topics to discuss include medical care, housing, finances, and personal concerns.  You need to know how your loved one wants things handled if they are too ill or frail to manage on their own.  These critical conversations will provide you with knowledge and some peace of mind about their wishes and can help prepare you emotionally for what might come.

Physical Health and Medical Issues

• What steps are you taking to improve your own physical health so that you can function as a caregiver?
• Are you able to encourage your family members to take steps to improve their physical health so that they will be able to function at a level that is satisfying to them?
• Do your family members have a relationship with their health care provider in which they have a partnership with their doctor?  Have you met their doctor so that you can be a part of that partnership?
• Do you have a written record of your family member’s medical history, current medical conditions, and blood type?
• Do you have a written record of the prescription drugs your family members are currently taking and why?
• Has your family member identified who to call in an emergency? Has an alternate been identified? Are these people willing to assist if they are called? 

Housing and Financial Issues

• Have you discussed with your family members whether their present housing will work for them as their needs change, and where they would want to live if they need additional help? Do you know what housing and care options are available if your family member can no longer live independently?
• Do you know what housing and care options are available if your family members can no longer live independently?
  • Live with another member of the family (respite care for caregiver)
  • Adult day care centers
  • In-home care (household employer’s taxes, adaptive modifications of dwelling, personal care service agencies, home health care agencies)
  • Assisted living facilities
  • Dementia care facilities
  • Nursing Homes
• Do you know how to find and select the best available facility for your family members?
  
  • New LifeStyles magazine is one starting place to check for advertisements
  • Make a personal survey of a facility by appointment and then return for an unannounced visit or two
  • Ask to see most recent state inspection report
  • Check with State Ombudsman Program for complaints
  • Talk with the family council at each facility about problems
  • Present the acceptable facilities to your family member for decision
• Do you know how to respond if your family members objects that they cannot afford to live anywhere else because the house is paid for?
  • Ask a realtor to estimate the net value of house (allow for realtor’s commission and repairs required for the sale of the house)
  • Estimate annual yield if invested conservatively (Treasury bills or CDs)
  • Add annual expenditures for taxes, insurance, house maintenance (use average of last five years’ expenses or approximately 1% of value of house), utilities, exterminator, yard maintenance, and other ongoing expenses.
  • This yields the actual cost of living in a house that is paid for.  Use this figure to compare with facility fees.
• Do you and your family members have a realistic plan to pay for their care over the long term?
Retirement income: pensions and social security
• Personal Investments
• Reverse mortgage
• Long term care insurance
• Veteran’s Aid and Attendance or housebound pension
• Spend-down for Medicaid (eligibility requirements; spousal impoverishment)
• Have your family members shared the details of their financial affairs and the location of their legal documents, safe deposit box and key, military discharge papers, insurance policies, bank accounts, investment and tax records, deeds, and other property ownership papers?
• Have your family members given you the name and phone number of their CPA, banker, and financial advisors?

Legal and End-of-Life Issues

• Have your family members signed all the recommended legal documents and distributed copies to their health care providers as well as to persons listed as emergancy contacts?  Do you have copies readily available?
• Durable powers of attorney (both statutory and medical) so that someone your family members trust and a trusted alternate will have authority to act if they are unable
• An advance directive, also called a “directive to physicians” or “living will”
• A will or "last will and testament"
• A HIPPA authorization to allow you access to medical information
• Has your family members' legal documents been updated recently?  Have your family members introduced you to their attorney?  Are you aware that some organizations and agencies will not honor a power of attorney but require their own agency-specific forms instead?
• Do you know whether your family members need a representative payee to handle her dealings with the Social Security administration and Medicare?
• Do you know if the insurance company that carries your family members' Medicare-supplement policy will honor a power of attorney?  (AARP’s Medigap insurance carrier requires a special release, for example.)
• If your family member is a veteran, have you contacted your county Veteran’s Service Officer about the VA-specific power of attorney required for assistance in applying for benefits from the Department of Veterans Affairs?
• Have you and your family members discussed their preferences for funeral and burial?  Have you and your family members discussed their preferences for end-of-life care?
• In hospital or at home?
• Aggressive life support (respirator/ventilator, IV, feeding tube, antibiotics, CPR)?  When to stop aggressive life support?
• Palliative or comfort care? Hospice? Do not resuscitate (DNR) order?
• Organ donation?  (only if no dementia)
• Brain autopsy to confirm specific type of dementia?  Note: prior arrangements are required.
• After the death of a loved one it is normal to grieve but also important to accept comfort from others. Do you have a support system in place?