- Today at our fourth annual Final Affairs Conference,
we have Angie Joy and Barb Engelhart,
Information and Assistance Specialists for the Aging
and Disability Resource Center of Northwest Wisconsin.
And today, they're here to talk to us
about long-term care planning.
So please welcome Angie Joy and Barb Engelhart.
[audience applauding]
- Good afternoon. - Good afternoon.
- It's good to see you all. I hope you had a good lunch.
So, my name is Angie Joy,
and this is my coworker Barb Engelhart.
We are Information and Assistance Specialists
with the Aging and Disability Resource Center.
The ADRC is an agency that serves Polk, Burnett,
and the St. Croix Chippewa Tribe.
Thank you.
We are, we have offices located in Siren and Balsam Lake.
Barb is in the Siren office, I am in the Balsam Lake office.
We have a third coworker as well
that is in the Balsam Lake office with me.
The ADRC was an agency that was developed in 2009.
The state of Wisconsin reformed its long-term care system,
and the ADRC was developed to be
an impartial one-stop shop for information
about anything to do with aging or disabilities.
- An interesting note, between the two of us,
we have 55 years of experience working in long-term care.
We started when we were 12.
- We're only 29 now so.
[audience laughing]
What does long-term care mean?
Long-term care is any ongoing support
or service that helps with personal and or healthcare needs.
Today, we're gonna specifically discuss
getting your affairs in order, care and services,
financing long-term care, aging at home,
when aging at home is not an option,
and thinking about end-of-life.
- So where do we get started?
Planning for long-term care starts
by recognizing the changes that aging may bring.
For instance, our hearing, our vision,
our strength, our balance, and our energy.
Things that can complicate aging can be chronic conditions,
such as diabetes, where you're going to have complications
or it may be what you genetically inherited.
I have a mother or had a mother
who had macular degeneration.
It is likely that I may lose my vision in the years to come.
So just a little bit, alot of things we cannot control,
and genetics certainly is one of them.
- After we've recognized that changes will happen,
we need to think about it, talk about it, and plan for it.
It's important to plan ahead
because this will help reduce stress in a crisis situation.
So we always encourage,
start the conversation earlier rather than later so that
you're not forced in a crisis to make quick decisions.
We suggest that you talk with your healthcare provider
about your health or the health of your loved one.
Ask what you can expect over time,
what you can expect if you have a chronic condition,
what you can expect with the normal aging process.
If you have some specific chronic conditions,
you might want to bring a loved one with you
because two sets of ears are better than one.
We also suggest that if there's a lot of information
shared at a doctor's appointment,
you ask for something in writing from the doctor.
- Also, I think very important in this age of healthcare
privacy that if you are going with a loved one
or your spouse or your parent,
that you have them sign a HIPAA release
or they will not be able to communicate with you
if you have a concern or a question.
So, starting the conversation.
This is sometimes a difficult thing to do,
but we start that conversation with a parent,
a spouse, or children.
A lot of times adult children have a really hard
time recognizing that their parents are aging.
Don't want to hear about it,
don't want to talk about it, kind of in denial.
But there's a lot to talk about.
Your personal preference.
A lot of us don't agree on what each other's decisions are,
but it's important to me,
it's important to you to have what you want.
We'll talk about finances, health, and future planning.
And getting that conversation started,
maybe something as easy, like,
you know, I'd like to talk to you
about what's gonna happen in the future to me.
Asking someone if they have that
living will or an advance directive
or the power of attorney for healthcare.
A time to talk to someone also might
be at a time you are making a transition.
Maybe from home to a condo or a senior living apartment.
Those are the times you really want to have
that conversation, but it's never too early.
- It's important to listen to
and respect one another's ideas.
Independence is vital, and so family or friends
may have a different idea of what is needed.
So it's just important to respect each other.
Getting your affairs in order.
The first step in planning.
So now we've recognized that change
is going to happen and we've had the conversation.
The first step in planning is to get
your personal affairs in order.
In the event of illness, disability,
or even death it will be very helpful
to your loved ones to make a few simple things now.
We suggest that you start by making
a list of your important papers.
Make sure the list includes where your papers can be found.
Any advance directives for healthcare,
make sure that they are given to the person
you designate and also to your medical doctor.
And also make sure that if you do a list,
you can tell your loved ones
where they can find the important documents.
- You know, years ago we did not,
generations before us did not discuss
personal finance with their family.
That was something very private.
But we have to have that conversation now.
Especially knowing where the paperwork is.
My mother died five years ago
and had most of her paperwork all neat and tidy together.
But she did have a Prudential life insurance policy,
and I was the beneficiary.
We did not know about that policy.
And we have Prudential and some investments,
so you get those privacy notices.
I was tearing them up and at one point
opened it just because and there it was that
they were trying to get a hold of me, so--
- Final notice. - Yeah.
Don't take advantage that you're just throwing a privacy,
something might be very important in that paperwork
that you're receiving in the mail.
- We've included here a checklist of important papers.
Social Security and Medicare information.
Each year, if you are receiving Social Security benefits,
you will receive a statement in about November of each year.
It will tell you what your benefits
will be for the next year.
It's really important to keep this piece of paper.
It can be used as verification of your income
or your benefit if you ever do need
to apply for any type of services.
So we suggest you hang on to that.
Make sure you put on your checklist
where you can find your most recent will,
living trust, or power of attorney for healthcare.
Include important medical information
and a list of medications taken.
We encourage you and have included
in your bags today this file for life.
This is something that can be found--
It contains all the important information
and can be left right on your refrigerator.
If your medications change often,
you may not want to list them on here,
but just ask for a copy from your doctor
and tuck them in the back.
[man speaking]
- It has a nice magnet on the back for you
to stick on your refrigerator in case
ambulance crews come in, they know where to find that.
- We suggest also keeping on your list
where your birth certificate, marriage certificate,
military discharge papers,
or citizenship paperwork can be found.
If you are a veteran,
you will need your discharge papers
for any benefits that you might be eligible for.
Include names of banks, account numbers,
your tax returns, insurance information and policy numbers,
contact information for your doctor, your attorney,
or your financial advisor, sources of other income other
than Social Security, liability, such as mortgages,
debts, or property taxes, deeds and trusts for your home,
your car titles and registration,
and also where your safety deposit box is
and where the key might be located.
- And in case you didn't know this very important note,
if the person that you have entrusted with making
decisions for you and all your paperwork
does not know where you keep that key,
you will need a court order in order
to open that safety deposit box.
So always making sure you get that person
a key and they know exactly where it is kept.
So, who will make decisions when you no longer can?
Planning ahead means that you get to decide
about your healthcare, your living will,
power of attorney for healthcare, DNR,
for those of who don't know, that means do not resuscitate,
finances, power of attorney for finances,
a conservator, a rep payee, and guardian.
Estate would be will, probate, living trust,
and an estate planning attorney.
So, what happens if you don't plan ahead?
Well, somebody may have to make decisions
for you that you don't know.
Many times you get a disinterested third party
if families are not getting along.
And then that person is just
guessing at what you might want.
So if you leave here with anything, please do pre-planning.
Get that power of attorney for healthcare.
- To ensure that your choice will follow.
- A guardian or conservator may need to be named by a judge.
Also, if you don't pre-plan,
you'll have to do things through probate.
There are ways to avoid probate,
and probably the financial attorney can help you with that.
- And now we'll take you through a little more detail
on each of those that Barb just listed.
Healthcare advance directive,
in the event of illness or accident,
if you are no longer able to make decisions
for yourself due to an incapacity,
a healthcare advance directive can guide
medical decisions and care on your behalf.
Using a healthcare advance directive can make a difficult
decision easier for medical personnel and your loved ones.
- So, a little more about healthcare advance directives.
There are three common types.
The power of attorney for healthcare,
living will, and the do not resuscitate.
The power of attorney for healthcare,
as we've stated before, let's you name someone who will
make decisions for you when you can't.
You can name a family member, a trusted friend,
or an unmarried partner.
You can give a copy to the decision-maker,
your doctor, and keep a copy for your records.
If you choose to make one after the first one you've made,
if you change your mind,
the one that you did prior will be negated
by the newest one that you have done.
Just a reminder to make sure that you're letting everybody
know when you have changed it,
especially for your medical record, your provider.
The question that always comes up is, I'll ask somebody,
do you have a power of attorney for healthcare?
They'll answer yes. I'll say, is it activated?
And they look at me like they don't know what that means.
So, when you do a power of attorney for healthcare,
that is your prevention tool.
Once you have been deemed incapacitated,
the doctor has a form where he will sign
and get another colleague to sign
in two places that you are incapacitated.
Now, that doesn't mean that you're always
going to be incapacitated.
Let's say you're in the hospital,
you can't make a decision,
you've had a slight stroke, with rehab you come back.
That doctor can deactivate your power of attorney
so you are back to making decisions for yourself.
A living will outlines medical wishes
and the type of care that you do or do not want.
Options for people who do not have a person
to appoint to their POA of healthcare.
As I've said before, the do not resuscitate
is a formal request that you make with you
and your doctor in case your heart stops beating.
A lot of people that feel really strongly about DNR,
I would advise them to get a bracelet
because if you fall on the street or pass out
on the street and EMTs are called,
they are going to resuscitate you unless you specifically
have that bracelet on and turned, obviously,
the right way because that's what their job is.
- I just want to touch a little bit on the living will.
Barb said this, but the biggest difference
between the power of attorney for healthcare
and the living will is if you do not have somebody
specific that you'd like to appoint,
the living will can be used for you to still write down
what your wishes are, what you hope for your medical care,
and then your doctor will have that
information to act on your behalf.
Healthcare advance directives.
I'm going the wrong way again.
So, writing a healthcare advance directive.
You can do this by using.
It's just a form, a legal document.
Your healthcare provider will have them.
We have them at the Aging and Disability Resource Center.
All local ADRCs will have a copy of this.
The hospice agencies may also have a copy of them.
If you were hospitalized,
you may have already completed one,
and you might have that on file.
You can also do it by working with your attorney.
Advance directives may need to be notarized
or witnessed by two individuals.
And it's always important to give a copy to your doctor,
your medical provider, the person you designate
to make those decisions, and then keep a copy for yourself.
- Financial advance directives.
Your options are a power of attorney for finance.
It's a legal document. It's quite lengthy.
It allows you to give the right
to manage your financial affairs.
You get to choose when this is activated.
Most of them are activated at the time of signature
or if you're no longer able to make decisions for yourself.
A conservator is a legal proceeding that allows
you to have somebody deal only with your finances.
It is a court appointed conservator,
which means you have to go to court
and the judge will ask you if you voluntarily
give someone permission to make decisions for you.
You can change that at any time,
and, again, it is totally voluntary.
- A representative payee is someone appointed
by the Social Security Administration
to manage a person's Social Security income.
So it's specific to Social Security.
- A guardianship happens, in many instances,
when a person does not have a power of attorney
for healthcare and is now deemed incompetent,
which is just a higher level than incapacitation.
A doctor fills out a five-page examining physician's report.
The guardian is appointed by the court.
And this may be needed if you get to a nursing home
and your power of attorney for healthcare document
says that that person may admit you to an assisted living
or to a nursing home, but you get there
and now you're a little,
have some dementia and you don't want to stay there.
Once you start vocally saying that that person
can't keep you here and you don't want to stay,
that's when people need to go back to court
to get that guardianship because only a protective placement
through the court can keep that person in a facility.
- So now we're gonna--
We've thought about it, we've talked about it,
and we've started planning.
Now we're gonna talk about services
that are available for long-term care.
So, again, long-term care means any ongoing support
or service that will help with
our personal and/or healthcare needs.
It's going to be very specific for each individual.
It could be care provided to you by your spouse,
your family, a neighbor, a friend.
It could be a home health aid, or it could be a nurse.
It is going to be care that could happen in your home,
in a facility, or in a community setting.
- So you consider the likelihood of needing care
possibly due to an illness, an accident, or a disability,
or just through the normal processes of aging.
- Long-term needs are going to vary depending on the person,
and they may include help with cooking,
shopping, cleaning, transportation.
They might include a need for assistance with personal
care that might include bathing or other grooming.
There could be a need for one or two hours a week,
or it could be full-time care.
- And the least fun thing to discuss about long-term care
planning is, "How am I gonna finance that?"
So, the costs of long-term care are gonna vary
depending on where you live and your location.
In Wisconsin, at least northern Wisconsin,
nursing homes can cost anywhere from about $6,000 to $7,500.
If you live in New York,
a monthly nursing home fee will be $14,000 a month.
That doesn't take very long to whittle away at your savings.
So, in-home services and assisted living,
they're going to be a little more reasonable for you.
And spending money on home to take care
of your needs early on is going to help you
maximize your long-term care dollars.
Maybe it's all you need is Meals on Wheels.
Maybe you just need some help with bathing,
just that extra supervision helps you
to do well longer in your home.
- So knowing the cost of what a service
will cost and what is available in your area
will help you plan for future before a crisis arises.
When looking at the options available,
are you going to be able to pay for private pay services?
Will you have VA benefits that might assist?
Are there other public assistance benefits
that you're already eligible
for that might have services that they cover?
Do you have insurance that will pay,
long-term care insurance,
or will you need publicly-funded dollars?
We have included in your packet,
and this is a publication by the Wisconsin Department
of Health Services, a cost calculator.
It's called Considering a Move, and it's a nice little tool.
There's a short version and a long version inside
that you can kind of lay out what options you're weighing.
What are you looking at?
Are you looking at a couple of hours of help
in the home versus an assisted living?
And you can calculate the cost,
and it helps you stretch your personal finances further.
Aging at home.
Most of us would like to stay home as we age.
To do so, we may need to make some changes to our home.
Again, we talked about talking to your physician,
planning for what changes might happen.
Even if you're healthy,
you're gonna see changes in your eyesight,
your hearing, and your mobility.
Looking at what you can do will help you plan.
- So, changes to your home that you can make for it easier,
safer to live, might be adding grab bars in the bathroom,
making sure you put them at a very user friendly
part of your bathroom.
A toilet seat riser might just help you make
that transfer from standing up to sitting down.
Ramps work wonders for people
who have wheelchairs or walkers.
Also a safer way to escape your home if you have to.
Wider doorways make it easier for people
to get through with their wheelchair or with a walker.
And always our soapboxes is those pretty rugs
that help decorate your home are a danger to you as you age.
So removing those rugs, improving the light.
As our mobility chances and suddenly we're not picking up
our feet like we used to, we start shuffling,
those rugs get caught in our ankles,
and pretty soon we're on the floor.
Falls are just a bad option that we don't want to hurt
our chances of getting to stay home as long as possible.
- We've included in your, when you registered,
this little pamphlet
and your local Aging and Disability Resource Center
will have options like this.
Just small, little things that we maybe didn't think of.
Like Barb said, rugs or lighting can make a big difference.
In fact, making some slight changes or improvements
to our home can prevent up to half
of all home accidents involving seniors.
So, resources.
We're gonna-- When you talk about resources,
we talked about what you might need,
and now how will you make that happen.
You're gonna start with natural supports.
What services or what options
do you already have in your home?
Your spouse, your children, your neighbors.
What are they able to do for you?
Another thought would be changes to your home.
We've talked about that.
Where can you go for resources for that?
Your local Aging and Disability Resource Center
will have information available.
In our area, Center for Independent Living
and other resources that might help
you for find medical equipment
or adaptions to your home.
The other option will be local services.
What is available to you?
Home delivered meals.
Personal emergency response systems, the little buttons.
Some of them now can sense when you fall.
You don't even have to push them.
And it's a relatively reassuring service
for usually less than $40 a month.
Home care agencies, support of home care, respite care,
transportation, hospice, and support groups,
all information that is available in your community.
- The ADRC sponsors prevention programs
several times during the year.
One of those is "Stepping On."
All these programs are evidence-based,
meaning that they work.
"Living Well with Chronic Conditions"
will help you live with the disease
that you may have and how to take care of yourself better.
As well as folks with dementia, there's memory cafes
that are starting up all over Wisconsin.
The ADRC and the Alzheimer's Association
and several other people will be sponsoring
a memory cafe in Amery.
This is where you can bring your loved one
and you come along with them.
You have early dementia,
and you're not necessarily socially isolating yourself.
- Our information is listed here.
We are the Aging and Disability Resource Center
of Northwest Wisconsin.
There is an ADRC that serves all 72 counties in Wisconsin.
- So when aging at home is not an option,
a lot of times it's not going to work for everybody.
Senior housing is an option.
Moving in with adult children may be an option.
It may not be an option for some.
Some parents don't want to be a burden to their children.
Don't take it personally if that happens.
There are a lot of reasons why it may or may not
be the best options for you.
Assisted living can include a help with daily living skills,
bathing, dressing, medications, socialization, and meals.
Nursing homes are going to provide 24-hour skilled care.
So a little bit more skilled services
and staff at a nursing home.
- When deciding where to live, first consider what is important
to you or to your loved one.
Ask friends or contacts what they know about
different facilities or options available.
Visit different facilities.
If you like a facility, visit it more than once.
Visit it at different times of the day.
Ask both staff and residents what
they think about the facility.
- Checking out their activity schedule
I think is always wise too.
If you have someone who likes to stay busy,
it's important for you to look at what's going
on during the day, what meals are like.
Ask those hard questions.
- End-of-life.
Thinking about end-of-life or the death of a loved one
is not an easy thought, but it is part of planning.
It will include talking about your personal preference.
- Palliative or hospice care.
We have three hospice agencies available
for you to talk to today.
Palliative care is a new term that's kind of
a pre-hospice kind of care.
And hospice care is a Medicare benefit.
Planning for your funeral or memorial.
Pat Taylor is here.
He can discuss that, and he will have a presentation later.
A lot of people will write out their own obituaries.
They will put what they want
for their hymns or what their readings.
It's a great source of comfort for children
down the road when they really
might not have known what you wanted to say.
- When is it time to start talking about end-of-life wishes?
We encourage you to start today.
If possible, have these conversations
before a crisis happens.
It will make it easier for yourself
and loved ones when looking at,
when they know what you want for them.
Starting the conversation can be difficult.
You might want to wait for, you know,
a relaxed time or a place to talk.
You might need to initiate the conversation
by just saying, can we talk about this?
And don't be alarmed if there's resistance
or if you have to ask more than once.
And our last is connecting to the future.
As we age, it's common to reflect on our life
and look back at events that have happened to us.
- Tell your story.
I think one of the most important things
is every single one of us has our own story.
And how important for us to leave that legacy
behind to the people that may have questions
down the road and now they no longer can ask you.
Very, very important if you can
and are comfortable doing that
- There are several ways that you can tell your story.
We've listed a couple. You can create a scrapbook.
You could let a family member interview you
or do an audio or video and share some of your life memories.
You can write a journal or a memoir.
They make these little books too that younger generations
are asking older generations,
and it kind of starts the questions for you.
So it gets the conversation going.
And it's a way of documenting what somebody knows
and what their life has shared so that
it can be shared with younger generations.
Another suggestion is to go
through old photos and label them.
Just helping pass information on.
So that is it for us.
This is, we're gonna end now,
and then we'll take questions.
[audience applauding]