Life Care Planning

By Maureen Rulison
Caregiver Support and Resources

Caregiver self care. Now, that’s a loaded topic a lot of people struggle with. If you’re a caregiver – we actually prefer the person-centered term “care partner” –  you’re definitely not alone in feeling the stress. 

I feel it, too. Every day. For many of us who aren’t good at prioritizing ourselves while caring for an aging loved one, the physical and emotional consequences are severe. 

• 72% don’t go to the doctor for their own care as often as they should. 
• 58% have worse eating habits than before assuming care partner duties.  
• 63% higher mortality rate than non care partners.

The eye-popping stats go on. What’s worse, most of us are at least generally aware their stress is snowballing – making the job harder and damaging our own health. You know the reasons: feeling guilty, overwhelmed and the greatest barrier … time.    

How Well Are You Managing Your Caregiver Self Care?

You have to make time. You have to feel OK with filling your own cup. (Helpful hint: you can’t pour from an empty one.) Caregiver self care is essential for you to have the energy, patience and stamina to provide the best care possible for your loved one. 

1. Feel OK with Prioritizing Your Well-Being 

It’s one thing to say, “I have to prioritize my well-being.” Everyone can agree with that. But most care partners stop there. The most common barrier? Guilt. 

You should genuinely feel OK about caregiver self care. Make time for yourself every day, even if it’s just for a few minutes. Take a walk, read a book, or practice deep breathing. Do things that bring joy and relaxation like hobbies, socializing with friends or meditation.

Caregiver self care is not just important for your physical health, but also for emotional and mental well-being. Providing care for a loved one can be emotionally and mentally taxing, and neglecting self-care can lead to burnout, depression and anxiety. Setting realistic expectations for yourself and seeking support from others can help maintain a healthy balance. 

2. Seek (and Accept) Help

Here’s another one care partners tend to get hung up on. So many feel like they’re the only ones willing to sacrifice or assume responsibility. Some believe they’re the only ones who can care for their loved one “the right way.”  

Stop that toxic thinking now! Get comfortable seeking (and accepting) help.

A great life-care plan should include support and respite in regular intervals. Accept help from family and friends. Family, friends, community agencies and religious organizations are often happy to help with tasks like grocery shopping, cooking or running errands. Your plan also needs to be flexible and factor who will fill in during emergencies. 

Caregivers may feel guilty for accepting help. It’s not a sign of weakness, but a sign of strength. 

3. Exercise Regularly

Regular exercise is a must for caregiver self care. Exercise reduces stress and anxiety, boosts mood, and improves overall health. Find an exercise routine that works for you, even if it’s just a short walk around the block.

You can even find exercise routines specifically designed for caregivers, like chair yoga or Tai Chi, which can be done in your own living room. Being physically active helps you stay healthy and energized, and better able to handle challenges. When finished, you’ll feel accomplished and return to caregiving duties refreshed and reinvigorated. 

4. Stay Connected

It’s easy as a care partner to become so consumed that you gradually slip away from the outside world. If you’re not careful, days can turn into weeks, months and even years without any meaningful connection outside your caregiver role.

Keep in touch with people who are important to you, whether it’s through phone calls, video chats and/or social media. (Don’t assume it’s their responsibility to reach out first, as they may simply not want to bother you because you’re so busy.) 

Staying connected with family and friends is essential for normalcy and to reduce loneliness and isolation. Join social groups or organizations that align with your interests – and carve out time for ACTIVE participation. 

5. Eat Well

So many caregivers have trouble eating well. It’s easy to understand why. When pressed for time, as we so often are, we choose easy fast food versus more nutritious meals. Some care partners even neglect to eat while prioritizing the needs of their loved one.

Taking the time to eat well. Your body and mind need fuel. Include plenty of nutrient-rich foods, such as leafy greens, berries, nuts, and lean proteins. Limit processed and high-sugar foods, as these can cause spikes and crashes in your energy levels. Additionally, stay hydrated by drinking plenty of water throughout the day.

(As a pleasant side effect, your healthier cooking decisions may improve your loved one’s health and make your job easier.)

6. Get Enough Sleep

Caregiver self care requires enough sleep every night, even if it means taking a nap during the day. As a caregiver, it can be challenging to sleep well, especially if your loved one requires around-the-clock care. But it’s so essential.

Lack of sleep can cause fatigue, irritability and difficulty concentrating, which makes caregiving even more challenging. To improve your sleep quality, establish a consistent sleep schedule, avoid caffeine and alcohol close to bedtime, and create a relaxing sleep environment. Ask family members or friends to take over for a few hours. Don’t feel guilty about hiring a professional agency, if possible, to assist care so you can catch some Z’s.

Call your doctor if you’re having symptoms of sleep disorders, such as insomnia or sleep apnea. 

7. Set (and Enforce) Boundaries

Set boundaries with your loved one and others involved in their care. It’s important to communicate your needs and limitations, set realistic expectations, and enforce your wishes for your own well-being. If there’s something you can’t do, advocate for yourself so the life-care plan can include other accommodations.  

It can be challenging to balance your own needs with those of your loved one, but it helps prevent burnout and resentment. This can include setting limits on the number of hours you can provide care each day or week, delegating tasks, or simply saying “no” when you need a break.

In my career as a life-care planner and Board-certified Patient Advocate, I’ve seen bitterness fester into irreconcilable family feuds without the clear communication. Remember, setting boundaries is not a sign of weakness or selfishness. It’s necessary to operate effectively while seeing to your caregiver self care.

8. See a Counselor

Everyone can benefit from this – even those who otherwise feel OK. See a licensed therapist, counselor, spiritual advisor, or whatever professional is best to help you make sense of powerful feelings. Support groups can also help care partners deal with all of it, if talking one-on-one isn’t your style.

It’s human nature to crave someone to share emotions with. Yet so many avoid this route to caregiver self care, too. Bottling up for months – or even years – is damaging to your own health. 

Caregiver Self Care Tips to Be Healthy & Prepared

You can’t take care of your loved one if you’re burned out and sick. Caregiver self care is absolutely critical for your physical and emotional well-being – so you’re healthy and prepared to tackle the heavy work. 

Take time to recharge your batteries, relax and do things that bring you joy. Prioritize yourself. You only have one body and mind to be the best care partner possible.

If you need help building a life-care plan that factors caregiver self care, we’re happy to guide the process with compassion and understanding. Contact me at maureen@caregiversupportandresources.com.

By Maureen Rulison
Caregiver Support and Resources, LLC

We’re here to help. And, yes, I mean actually help your life-care planning process, without the sales pitches and noise. Last month, myself and a few associates – who all serve the continuum of care planning – held our first FREE Ask the Experts forum for residents of the Greater Tampa, FL area.

It was so refreshing to address our respective elements of life-care planning from finding the perfect senior housing and financial planning to end-of-life and funeral arrangements. There are certainly a lot of moving parts. (That’s why it takes four of us to address them!) 

But don’t worry! A little consideration and discussion with the loved ones and professionals who form your care-partner team goes a long way. Life-care planning doesn’t need to be nearly as daunting or complicated as it seems. 

We’ll be hosting our second FREE Ask the Experts forum at 9:30 am Thursday, May 18th at Veterans Funeral Care, 830 N. Belcher Road, Clearwater, FL. 

Want to Learn More About Life-Care Planning? Attend Our Ask the Experts Discussion! 

Here’s a little about us (and what you can expect): 

Patrick Blyeth – Veterans Funeral Care

Managing Director & Lead Pre-Need Counselor – Clearwater, FL

Patrick Blyeth assists military veterans and their families to execute their end-of-life wishes on their terms. Funeral and burial planning is more than just final arrangements – and how to pay for them. Everyone deserves a dignified goodbye as we transition from this life to the next, especially military veterans. Mr. Blyeth will discuss the planning process and how to craft the most meaningful funeral and memorial services for ourselves and our loved ones.

G. Andrew Gracy – Peebles & Gracy, P.A.

Estate Planning Attorney – Dunedin, FL

As we age, in good health or bad, there are a LOT of financial considerations. Not only for how to pay for our medical care and final expenses, but how to ensure financial security and stability for future generations. Andrew Gracy is an estate attorney and Medicaid-eligibility planner who works to ensure your money and assets stay where they need to be: with your loved ones. He will discuss planning tips to avoid hefty tax bills, cover the astronomical cost of assisted-living/nursing care, and protect assets.  

Michael Post – Sunways Senior Living Concierge

Senior Living Concierge – Sarasota, FL

Diving into the life-care planning process doesn’t mean anyone’s “near the end.” In fact, you or your loved ones may have many wonderful years left to enjoy living independently before moving to higher levels of care. You wouldn’t purchase a home without a real estate agent. Similarly, transitioning to senior living also requires an expert to assess options and guide all requirements. Michael Post helps individuals and families to secure perfect-fit senior housing, assisted living and nursing care arrangements. He’ll discuss senior housing realities and how to plan now for later needs.

Maureen Rulison – Caregiver Support and Resources, LLC

Life-Care Planner & Board Certified Patient Advocate – Clearwater, FL

Last, but not least, is yours truly! I guide individuals and families along the life-care planning process in its entirety – from patient advocacy to Medicaid & VA planning to care-partner team building. I lead this process with a guiding and caring heart. Why? Because I’m a care partner myself – to my life partner, Brian, who lives with Alzheimer’s and vascular dementia. I’ll be addressing every step of the journey and how to develop a well-rounded, flexible life-care plan that covers all needs.

We Can’t Wait to See YOU at Ask the Experts for Life-Care Planning Tips!

This event will again be FREE and OPEN TO THE PUBLIC. And here’s our promise to you: there’s no agenda to sell a product or service. Our Ask the Expert events are meant only to provide life-care planning tips and insights from decades of collective experience. Each participant will receive a life-care planning book that can be used during any one-on-one appointment with their desired professionals. 

By Maureen Rulison
Caregiver Support and Resources, LLC

There’s so much to consider in life care planning. You’re worried about health and financial stability for your loved one who requires care (and everyone else involved). You must also factor family relationships and personal realities in this puzzle with many moving parts. But despite our best efforts to predict the future, unexpected emergencies can completely derail even a great life care plan.

From sudden illnesses to financial struggles – and even natural disasters – it’s essential to be prepared for the unexpected to ensure that your loved one’s life care plan remains on track, or can at least adapt to changing realities.

What Could Possibly Go Wrong? Here are Some Common Life Care Plan Emergencies

That’s the million-dollar question: what could possibly go wrong? Unfortunately, we’ve seen too many care partner teams assume, with a solid life care plan in place, that everything is going to be fine. But a plan with no flexibility can make even minor emergencies worse. 

Here are some realities to consider:

1. Family Emergencies

Family emergencies – like the unexpected death of a supporting care partner or a divorce – can place significant strain on your life care plan. Essentially, you can never guarantee who will be there to help tomorrow. The neighbor who frequently checks on your mother may become ill herself. A daughter-in-law may quickly become an ex-daughter-in-law. 

The list goes on.

Events like these can carry emotional stress, financial strain, and loss of support you previously counted upon from family members and/or close friends. Couple that with the uncertainty of adjusting roles in the life care plan, and already heart-wrenching scenarios can become fatal flaws.  

2. Sudden Illnesses

Caregivers can have health issues, too. We’re all human. While your loved one is intended to be the focus of care, it’s easy to see how poor health within the team can throw a wrench in an otherwise well-oiled machine. 

Sudden illnesses can be both physically and financially debilitating. They can result in extended hospital stays, rehabilitation and lost wages from time off work. So caregiver self-care is imperative. It’s also vital that care partners have some sort of adequate health insurance coverage. 

Your care – before you can care for someone else – won’t accomplish much without your own health and stability.

3. Financial Hardship 

Finances are one of Americans’ greatest stressors. Nearly two-thirds of us live paycheck-to-paycheck. Yet, the responsibility to care for loved ones doesn’t care how much (or little) we make.

Job loss can pull the rug out from under anyone. Without a slush fund, paying bills and maintaining a lifestyle – while still caring for your loved one – would be nearly impossible. A network of professional contacts that can assist you in finding a new job is incredibly valuable.

Market fluctuations also can significantly impact financial stability, particularly if you have investments that are heavily tied to the stock market or property. It’s easy to get under water when market factors beyond your control send prices soaring and value plummeting. Diversify your investments to prepare for market volatility, so dips and recessions can’t cause quite so much damage.

4. Natural Disasters

People tend to leave these potentials for last in a life care plan. But a hurricane, forest fire, tornado, earthquake, 500-year flood or some other cataclysm is always waiting on the other side of tomorrow.

My life partner/care partner, Brian (who lives with dementia) and I live in Clearwater, FL. There seems to always be a tropical storm, at the very least, heading our direction during hurricane season. Just last year, Hurricane Ian narrowly missed our area, but forced our evacuation and caused a series of nightmares that could’ve derailed our life care plan indefinitely.

The physical damage was the least of our concerns. Stress and changing environments with dementia can certainly speed up the disease’s progression. Not to mention the travel issues that would’ve left us trapped and without access to emergency services for days or weeks. 

So it’s important to have a disaster preparedness plan including contingencies for evacuation, the location of shelters, and close care partners who could provide assistance when emergency services can’t reach you.

Are You Prepared for Emergencies in Your Life Care Plan?

To prepare for family emergencies, it’s important to build and nurture the care partner team. Your team is your support network, including close friends, family members and professional support services that are prepared to help when times get rough. If possible, work toward having a solid emergency fund in place, as well, so you’re not forced to choose between paying bills vs. necessary medical treatments. 

If you need help, Caregiver Support and Resources, LLC has over 25 years of experience  with all aspects of life care planning, including care partner team-building, Medicaid planning and board-certified patient advocacy. We’re happy to provide referrals and guide the process in a caring and compassionate way.

By Maureen Rulison
Caregiver Support and Resources, LLC

Life care planning can be an uncertain process. And it’s tough even when you’re working with things you do know – like if your father has a living will or that eventually your aunt’s cancer treatments will no longer be effective. But what of the things you don’t know? Are you prepared to factor the unexpected?

As my Brian’s life partner/care partner along his path with dementia, I’ve even had difficulty preparing for the unknown (and that’s as a professional life care planner and Board-certified patient advocate who’s been doing this work for nearly 30 years). We’ve encountered numerous scenarios beyond our control that required flexibility and adaptability – not only from us but from everyone on our care partner team. 

Of course, you always want to ensure your loved one’s well-being and happiness, no matter what the future holds. Because it’s not always good health, sunshine and rainbows. So it’s essential to plan for rough seas beyond the horizon when building a life care plan. 

Some Great Reasons to Account for the Unexpected in Your Life Care Plan

You can’t let your life care plan get too rigid. Essentially, this living, breathing document can’t be too sure of itself. 

• Will your older brother continue to age in good health? Or will a sudden and massive stroke leave him unable to speak the remainder of his days? 
• Will your assets be safe for the next 25 years? Or will the stock market crash again next week? 
• Will a trusted care partner be able to help your mother cook and clean? Or will he move across the country for work next year?

And these are just some of the potential questions and scenarios. One of the most significant advantages of having a life care plan is that it provides peace of mind for both you and your loved ones – when it works well. When the unexpected happens, it can be an emotional and challenging time.

But identifying risks and planning accordingly to have contingencies can ease the stress and uncertainty. Here are a few of the benefits of thinking ahead:

1. Protect Your Finances

Money can’t buy happiness, but it sure makes things easier. Unexpected events can put the worst possible strain on your family’s finances. If a loved one falls ill and needs medical treatment, the costs can quickly add up. In a poor economy, even the most comfortable families may fall upon hard times due to failing investments, plummeting property values or and/or unemployment. 

But by recognizing these possibilities, you can work to set aside that rainy-day fund when times are good to cover any unanticipated expenses if times get bad.

2. Ensure Continuity of Care

If something unexpected occurs, will your loved one’s care continue without interruption? In an emergency, who will be there to help? That’s something Brian and I experienced two winters ago when I became deathly ill with pneumonia, and others on the care partner team were not available due to work, travel and other responsibilities to address the emergency. It was the perfect storm. 

If a primary care partner becomes unavailable, you MUST have backup arrangements to ensure that your loved one’s needs are still met. And then have backups for those backups. And then fire drill that plan to ensure continuity of care actually works when disaster impacts your life care planning.

3. Avoid Confusion and Disputes

Unexpected events can cause confusion and argument, particularly if you do not have a plan in place. If a loved one falls ill and requires medical treatment, there may be conflicting opinions on the best course of action. Does your loved one see a certain doctor or avoid a certain medication/treatment? Did they spell out certain financial or legal wishes that may be necessary in an emergency – years or even decades before they should’ve been?

Unexpected realities don’t have to be unexpected. You can avoid such confusion and indecisiveness by planning so everyone is on the same page when it comes to your loved one’s care. Well-communicated planning ensures your loved one’s wishes, well-being and happiness are taken care of, no matter what the future holds. 

4. Have Peace of Mind

A step further, life care planning with some foresight provides peace of mind. Even if you’re not a Type A person, being able to rest easy is worth its weight in gold. Just knowing helps – even if your life care planning works to know what can’t yet be known. 

Of course, unanticipated events cause stress, anxiety and uncertainty. Your life care plan can address issues that aren’t even on your radar today to ease the burden tomorrow. 

5. Adapt to Changing Needs

As your loved one(s) and the care partner team move through life, there will inevitably be proverbial fires to put out. But not all of them are five-alarm blazes. 

Life is unpredictable, and a life care plan that factors the unexpected offers the flexibility to accommodate changes as they occur. Your loved one’s health won’t follow a playbook – good or bad. So your life care planning should be easily revised to accommodate changing needs. A new diet may be required, or a loved one may no longer be available to stop by for brief “coffee visits.” That’s fine. Let’s plan around that!

How Can We Help with Your Life Care Planning Needs?

I work with care partner teams every day to guide the life care planning process and coordinate resources needed for each step of the care journey. These plans may be specific, but they also require flexibility.

We all face important decisions – in good health and bad, expected or unexpected. There are many moving parts to planning care for quality of life and financial protection. You need an expert life care planner and Patient Advocate who knows each required step for your loved one’s well-being today and tomorrow.

Contact me at maureen@caregiversupportandresources.com to get started today.

By Maureen Rulison
Caregiver Support and Resources, LLC

We prefer it, even if so much of it is centered around language alone. What is person-centered care? It’s a philosophy that empowers the individual at the center of care. Sometimes individuals, as couples later in life often prefer to trek the journey together. 

How is it so empowering? We’ll give some examples:

• My life partner/care partner, Brian, lives with Alzheimer’s and vascular dementia. He hates being labeled as a “sufferer” of dementia. Negative language itself places him at a disadvantage. He’s not a “sufferer.” He simply lives with the disease. 
• A wonderful woman living in an advanced-care facility complains about medication side effects. The doctor “in charge” of her care won’t listen and says, “It’s best for your condition.” Is it, though? With person-centered care, the woman directs her care, and it’s the doctor’s responsibility to use their expertise to find better options.
• A married couple agrees it’s time to research assisted-living homes. One spouse is becoming quite sick. The other is in great health. But they both wish to go in together. Their children disagree. Whose decision is right? With person-centered care, their choice should be honored because they believe being together improves their lives and care outcomes.

Person-Centered Care & Language Empowers the Individual

Now let’s break it down a bit further. It’s also referred to as person-focused or person-directed care. Tomato/to-mah-to – they accomplish the same thing: empowerment over care decisions and everyone’s God-given right to live and die with dignity.

Here’s how.

A Voice & Choice in Care Decisions

Once upon a time, in a galaxy not so far away, medical professionals called all the shots. They analyzed, made a decision and ordered it done. Now, of course, there are still medical professionals who operate this way, but the overwhelming trend toward person-centered care is rendering those methods obsolete. 

Yes, doctors, nurses and other pros in the continuum of care have years of education and experience that we must consider and respect. But who knows their body and mind better than the person living in it? Who knows how it feels? Who knows how it reacts? That’s right: you and/or the loved ones entrusted with care decisions. Care isn’t being given from a higher power. It’s being coordinated by equal voices. (Helpful hint: With some great life-care planning, person-centered care allows people to speak for themselves even after they can no longer speak.)

Words Matter

Person-focused language is compassionate. Our loved ones deserve that compassion – whether they’re aging in good health or bad. It’s fair. It’s balanced.

Terms like “caregiver” aren’t as fair and balanced as the person-focused term “care partner.” “Caregiver” connotes a superior relationship between a person who is “more capable” and one who “can’t care for themselves.” While “care partner” connotes an equal relationship – a “partnership in care.”

The list goes on:

• “Resident” – someone who lives in a place vs. “Patient” – someone dependent on care.
• “At risk for falls” – someone who may fall vs. “Falls risk” – a demeaning label.
• “Prefers not to” – expresses personal will vs. “Non-compliant” – a label of insubordination.
• “Facility” – an institutional setting vs. “home” – a place of comfort and healing. 

Person-centered language removes labels and restores power where it should be: with the individual.

Building Your Circle of Support

What is person-centered care if not a way to mobilize the people, programs and professionals that’ll make life easier? The individual has the power. They know best. They know who knows them best and will provide the most effective and fulfilling life care. 

Your loved one sits at the center of the care-partner circle. They receive care, of course, but with person-focused care, they have the most important job: directing care. Everyone else surrounding them – from siblings and spouses to doctors and faith leaders – play equally vital roles providing love, support, guidance and medical treatment.

Reversing the Stigma

Along the same lines as person-focused language, this care philosophy does a fantastic job changing negative perceptions about aging and illness. The stigma, if you will.

A lot of this stigma can be attributed to culture and media. It’s hard to feel good about oneself when the global narrative glorifies youth, beauty and fitness at every turn. Thus, recognizing age and illness as natural human processes becomes more difficult. Who wants to be seen as “ugly” and “frail”? But getting older isn’t ugly, and illnesses we don’t choose aren’t weaknesses. Person-centered care, in turn, recognizes and honors our loved ones living through the reality life throws at everyone eventually.     

Different Strokes for Different Folks

Sometimes seeking alternative approaches and perspectives – thinking outside the box – yields better results. You’re correct in requiring other options and opinions. Under person-centered care, health professionals are obligated to use their expertise to provide those alternatives themselves (or at least indicate the right direction).

This empowers your loved one during doctor visits and other wellness consultations. Years ago, top-down approaches and one-size-fits-all treatments relegated care recipients to obedience. “Follow the doctor’s orders” was the common phrase. But no one, professional or not, should dictate care beyond the individual themselves.

So What is Person-Centered Care? It’s a Gateway to Better Care … On Your Terms

People aren’t defined by their care needs. Those who provide care aren’t in charge. The person-centered care philosophy – in both words and actions – restores power to the individual. Our good friends at the Pioneer Network and Eden Alternative have led these culture-change efforts for decades.

And here at Caregiver Support and Resources, LLC, we explore all paths to person-centered care through Board-certified Patient Advocacy, life-care planning and more. We’re happy to guide the process in a caring and compassionate way. 

Email me at maureen@caregiversupportandresources to discuss your needs – because we value you as an individual.

By Maureen Rulison
Caregiver Support and Resources, LLC

Your parents (or other loved ones) are getting older. Most of us at this stage – watching them enter their “golden years” while getting “up there” ourselves – try to assess “the damage” to see when it’s appropriate to make BIG DECISIONS. Can life-care planning wait a few more years? 

While otherwise healthy, they’re showing some signs of aging. You may say to yourself:

• “Why would I upset them now with talk of end-of-life care?”
• “They’re still working. Shouldn’t we at least get to retirement first before the tough discussions?”
• “I assume their finances are in order.”
• Or worse, “Someone else should have this talk with them.”

They’re common thoughts. Understandable even. But they’re also misperceptions, rooted in assumptions, uncertainty and the fear of upsetting others. At best, they’re also wishful thinking – a very human tendency to hope for the best and avoid considering the worst.    

So how long should you wait before starting the life-care planning process? If possible, the time is now! Don’t be among the two-thirds of American adults without a formal care plan. 

Can Life-Care Planning Wait? No. Here’s Why

To truly have a LIFE WORTH LIVING, life-care planning must be done ASAP so you and your loved one can focus on the real joys of life. Get it out of the way early, while everyone’s thinking clearly, so everyone can move on and enjoy the remaining years without worry. Because here are some realities:

• Years pass quickly – with or without action
• Emotions get stronger closer to “the end”
• Decision-making only gets harder
• Legal & financial matters can take years to resolve

We’ve said before that a life-care plan usually has about 9 parts. But let’s break it down even more simply into 3 easy steps.

1. Honor Your Loved One’s Wishes

A life-care plan must be personalized. It’s your Mom’s plan, or your parents’ joint plan, or your cousin’s or aunt’s. No one else’s. While your parent or other aging loved one is still healthy, it’s essential to learn their preferences directly from them. (My life partner/care partner, Brian, who lives with dementia, made this video to his future care partners while he was still cognizant enough to advocate for his needs and wants.) 

This gives the individual the opportunity to tell their own story while they still have the enthusiasm and mental capacity for it. Have them write it down or do a quick-and-easy video like Brian’s, or even say it into a recorder. Whatever works.

2. Build the Circle of Support

In our circle of support, it’s called the care-partner team. We prefer the person-centered term “care partner” to “caregiver” because even language requires a level playing field. “Caregiver” implies power over decision-making, while “care partner” implies an equal voice.

So let’s build the care-partner team. Your parent/aging loved one can choose those best suited to do individual jobs. It’s their choice, and it’s best to figure this part out early so the individuals involved can prepare. It’s in everyone’s best interest to have these conversations without grief or intense emotions. 

3. Build the Care-Delivery Mechanism

With the team in place and the loved one’s wishes factored, now comes a series of vital questions about care delivery: 

• How will care be delivered
• Who will deliver it?
• Where will it be delivered?
• How will it be paid for?
• What will happen in “the end”?

Determining all this early allows the team to have everything in place – from moving to assisted living to involving hospice to preparing financially and legally. Perhaps living happily and healthily at home is possible. Many times, it isn’t. Sometimes key members of the care-partner team can follow through on care promises. Sometimes their circumstances change. So it’s important to make the life-care plan a working document that’s flexible to change.

Can Life-Care Planning Wait? Not If You Want the Process To Run Smoothly

Even Type-A planners couldn’t reasonably be expected to work on a life-care plan while dealing with the emotional toll of an aging loved one. And eventually the aging individual may no longer participate meaningfully in the planning process. It benefits all parties to start having these conversations as soon as possible.

Caregiver Support and Resources, LLC helps the life-care planning process with a guiding and caring hand. Schedule your free consultation with me today. We want the same outcome as you: a LIFE WORTH LIVING for everyone involved.

By Maureen Rulison
Caregiver Support and Resources

Reflecting can be a good thing. But when it comes to the Long-Term Care Medicaid and the 5-year lookback period examining financial eligibility, it’s easy to feel overwhelmed. 

Many of us approaching the twilight of life intend on distributing our assets to loved ones anyways. But the government feels that if those assets are present within 5 years of needing to apply for Long-Term Care Medicaid, they’re fair game to cover the ASTRONOMICAL costs of advanced care.

“What the heck is a lookback period? How is that fair?” you may ask yourself. But it’s just the nature of the beast. A lot of paperwork and lots of red tape are expected for Medicaid, as with any government program. The laws governing it are difficult to comprehend. So we’re here to help.

Medicaid ensures you (and your spouse, if applicable) have not within the last 5 years artificially deflated your financials to achieve eligibility. But there are exceptions! Certain things like meaningful expenditures, gifts, exchanges and transactions can occur within the 5-year lookback period.

Medicaid 5-Year Lookback Exceptions to Keep in Mind in 2023

As you know, your story is told via a paper trail. It’s the government’s due diligence in allowing eligibility for Long-Term Care Medicaid. Simply put, you can’t have significant income and assets — or the state will declare you have the resources to pay for care yourself. 

But Medicaid does understand aging parents, grandparents and other loved ones would distribute wealth and assets in their older years that can’t be used in death. So the exceptions (loopholes, you might say) are there for sound legal and ethical reasons. Experienced estate planning and life-care planning professionals will know to factor these realities. 

1. Home Transfer

Equity in a home is one of the most common gifts to close family late in life and bequests after death. But if you’re planning on gifting a primary residence while still alive, be careful to do so beyond Medicaid 5-year lookback parameters. You may either place the equity in a trust at least 5 years before applying for Long-Term Care Medicaid to be distributed after your death, or you may transfer the property to the following individuals under certain conditions: 

• A legal spouse
• Children under 21 years old
• A blind and/or permanently disabled adult child
• A sibling of the homeowner who has resided in the home for at least a year before the Medicaid applicant transitioned to a long-term care facility
• An adult child of the applicant who has lived in the home for at least two years as a caregiver/care partner before the Medicaid applicant transitioned to a long-term care facility. (The provided care stipulation must be reasonably proven that the adult child providing care delayed the applicant’s need for formal long-term care.)

Of course, Medicaid would require proof of all these familial statuses and other variables to allow eligibility.

2. Married Couples with One Spouse Applying

Quite often, only one spouse applies for Medicaid. While one spouse remains healthy enough to live without assistance, well, the other one sometimes isn’t so fortunate. They must prepare to cover costs for a range of advanced care options – from extra home-care services and respite care to full-fledged nursing home placement. Most people need Medicaid to make that happen.

The Community Spouse Resource Allowance (CSRA) allows the non-applicant spouse to retain much of the couple’s jointly owned assets during the 5-year lookback period while the other still remains eligible.

Here in Florida, there is no penalty for interspousal asset transfers. The CSRA allows the non-applicant (known as a “community spouse”) to keep up to $148,620, while the applicant spouse may keep only $2,000. The thinking, easily enough, is that allowing such asset transfers (including non-residential property, stock portfolios and other investments, and cash savings) to a spouse will protect the applicant’s spouse and other dependent loved ones from having too little to cover living expenses.  

So let’s break down some hypotheticals (updated for 2023):

• If the couple together has $210,000 in net assets, the non-applicant spouse can keep $148,620 and the applicant may retain $2,000. The remaining $59,380 must be spent down or distributed within the rules.
• If the applicant spouse has $250,000 in cash savings alone, (s)he can transfer only $148,620 to the non-applicant and retain $2,000 within the 5-year lookback. 
• If the couple has just $78,000 in net assets, the non-applicant spouse may retain that entire sum.

After these determinations, the remainder of assets during the 5-year period may be used for long-term care costs – regardless of where the care occurs or who administers it.

3. Assets Distributed to Minor Children

Long-Term Care Medicaid applicants may have a minor child or children (under 21 years old), or those who live with any documented disabilities. These children would be eligible to receive asset transfers of any scale  to benefit their own well-being during the 5-year lookback period. 

Life-care planners and legal advisors often recommend establishing trusts to temporarily transfer ownership of funds and assets until the beneficiaries reach adulthood.

These Exceptions to the Medicaid 5-Year Lookback During Your Life-Care Planning

We always advise planning early to ethically and responsibly spend down/distribute assets and property. The best course of action is to have all financial planning and legal issues sorted out well before the lookback, if possible. The exceptions to this important eligibility rule do, however, account for unexpected illnesses and variables that should allow for transactions at any time. 

Professional to help to build a solid plan is recommended, and that is why we are here. Caregiver Support & Resources, LLC works with elder-law attorneys, and we can legally and ethically protect people’s assets to help them qualify for Medicaid and VA attendance. If you need assistance, contact me at maureen@caregiversupportandresources.com.

(Editor’s Note: Caregiver Support and Resources, LLC is not a law office. Maureen Rulison is not an attorney. The information contained in this blog is not to be construed as legal counsel or advice or substituted as such in any U.S. state, territory, locale or foreign state where it can be accessed. Rather, this blog is meant only to educate elders, care partners and families as to legal processes around life care planning.)