Long-Term Care Costs, Issues Elicit Strong Emotions

A little preparation can ease the conversation with Mom or Dad about their own plans.


By Claude Thau


    A delicate challenge many of us face is broaching the subject of Mom’s/Dad’s potential future need for long-term care (“LTC”). These tips may help you raise the topic effectively.

    When someone needs LTC, each relative experiences lifestyle, emotional and financial impacts, directly or indirectly. More than 40 percent of primary family caregivers suffer clinical depression, 1 and caregivers are likelier than non-caregivers to eventually need LTC themselves, despite dying sooner.2 Preparation can reduce these problems. For clarity, we’ll refer to “Dad” here rather than “Mom.”

    Think your sibling will be the caregiver? Her relocation or something else may “promote” you or your spouse. As fewer unemployed daughters are available, more males become caregivers.

     If you don’t raise the topic optimally, parents might say: “Is she planning to put me in a nursing home?” or “My daughter is worried about inheritance.” And children often give assurances that “Dad. I’ll take care of you,” perhaps digging a hole for both generations.

    Relatives may help you anticipate Dad’s fears and how to address them. One way to start: Ask what you should know in case of emergency. Do you know Dad’s hospital, doctors, lawyer and financial advisers? Has he completed healthcare advocacy forms? Where does he keep important papers?

    Talking about another person’s challenges can start the conversation: “Has Aunt Rose made plans to remain as independent as possible if she needed LTC? Would she want to relocate? What (type of) venue would she prefer? Could she stay at home? Who would she want to manage her affairs and/or be her primary caregiver? Are those people prepared? How would it affect them and their families?” Alternatively, start the conversation by telling Dad about your own plans for long-term care.

    Eventually, shift to him: “If you needed LTC, would you want to stay at home? What could we do to support that intent? Might you like a one-story home, perhaps closer to us, or an apartment close to restaurants and a movie theatre?

    Other conversation pointers:

  •  “I know Mom would take care of you, Dad, but many people need LTC after their spouse dies or becomes too weak to bear the burden. We would help, but couldn’t be here all the time. Advance planning lets you maximize control and comfort.”
  •  “You can reduce risk by making your home safer and adapted for seniors. Many elders discharged from the hospital don’t know what to do and are unable to select good providers. Let’s document your preferences and organize ourselves to achieve your goals. We could find a geriatric care manager now and meet with them annually, so they know your preferences and can defend your interests.”
  • “We could buy insurance to pay for home care.” If Dad objects that LTC insurance is for nursing homes, you might say “Do you think I’d rather visit you in a nursing home than here?” or “I’d much rather bring the kids here, where they can play in the yard and develop fond memories.”

    If Dad thinks you’re worried about inheritance, you might acknowledge that “insurance can protect inheritance, but proper care helps you live longer, delaying inheritance.”

If long-term care issues are not addressed with conversations in advance, children of aging parents could bear a heavy, costly, and unnecessary burden.

    Maybe Dad could pay for LTC with his income or assets, but many people who “self-insure” don’t get desirable care because, as we age, we fear (often irrationally) outliving our assets, so we won’t hire caregivers. Others resist spending money on care, thinking their children/grandchildren could benefit from the money or that it is too expensive. It is a lot easier to spend an insurance company’s money!

    Based on past statistics, half of 65-year-olds will need care for more than a year. Those people average nearly 4 ears of care. Generally, people can recover all their LTCi premiums by using their full monthly benefit less than a year. 

    If Dad thinks the government will provide care, you might explain that he’d have to spend his assets and have limited income to qualify for Medicaid, which doesn’t provide home care. If he says his parents died suddenly, you might observe that their causes of death don’t kill people as often today. Or, Dad might say he has excellent genes, hence won’t need LTC. However, people who live a long time are more likely to need LTC eventually. 

    In extreme cases, if Dad says he’d consider suicide, you might point out the potential impact that such an act would have on surviving family.

    If Dad thinks he can’t qualify for LTC insurance, review his conditions, medications (name, dose, frequency and purpose), then contact a professional adviser.

    Please send the author your suggestions regarding such conversations. 

1 Houston VA Medical Center and Ohio State University, Dec01 reported 43%; National Family Care-givers Alliance, 1998 reported 67%

Caregiving as a Risk Factor for Mortality, The Caregiver Health Effects Study, Richard Schulz, PhD; Scott R. Beach, PhD, JAMA. 1999;282:2215-2219.  

About the author

Claude Thau is owner of Thau, Inc., and affiliated with Target Insurance Services in Overland Park, Kan.