When his mother could no longer fend for herself, William Pabst learned there’s no playbook for assuming a parent’s medical, financial and legal affairs if their mental capacity quickly deteriorates. And when his mother passed away in the fall of 2020, difficulties and frustrations continued.
Having power of attorney makes it possible to assume a parent’s financial responsibilities — but not necessarily easy. Barriers can remain in the form of institutional procedures and online security measures. The effort to sort it all out drains more time and effort than adult children could ever expect.
That’s what Pabst came to realize as his mother went through her struggle with a progressive, degenerative neurological condition that affected her body and mind. As the only child, Pabst jumped in to assist his mother and meet her needs.
Pabst, now a system administrator at Loudoun County Fire and Rescue in Leesburg, Virginia, and a former help desk manager at U.S. News & World Report, was there each step of the way as his mother’s situation followed a continually changing trajectory.
She went from living independently in her home, to repeated hospitalizations related to her degenerative condition, and then a stay at a skilled inpatient rehabilitation facility. She received physical and occupational therapy to help maintain her range of motion and motor skills, and speech therapy. “Her voice was getting quieter, and she was struggling with basic tasks,” Pabst recalls.
The rehab facility also managed his mother’s medications, which turned out to be an essential service — as he and his girlfriend soon found during the week his mother stayed with them immediately after her hospitalization.
“That was an eye-opener,” Pabst says. “I had the good fortune to have a partner who had cared for her elderly grandmother. Still, it was incredibly disruptive, and we could tell we were out of our depths.” Safety was also a concern.
Pabst located an assisted living facility for his mother, which afforded a period of adjustment and stability. Then, the COVID-19 pandemic hit. The facility pivoted from the social programming and communal dining that kept residents engaged to lockdown mode for infection control.
When Power-of-Attorney Falls Short
“Staying confined to her apartment for months with nowhere to go, with nothing to do, not allowed to see anybody, friends, family or otherwise — it just crushed her,” Pabst says. “The change in lifestyle forced on people was very deleterious.” That was the situation at the time his mother died.
Through all this, Pabst was doing his best to oversee his mother’s care, get a handle on her accounts, pay her bills and sell her home to finance her care. At his job, “there was a level of distraction,” he says. “But I was fortunate enough to have both a supervisor who was well aware of the time and energy involved with aging parents and also a girlfriend who was — and is — doing the same thing. Work was the only stable thing in my life.”
Pabst had a power-of-attorney document. With the nature of his work, he has technical awareness of the security layers involved in online accounts. Even so, he found tremendous challenges in accessing his mother’s accounts to manage her affairs as needed, and he certainly wasn’t prepared for the scope of paperwork required.
“Just because you have this piece of paper in hand doesn’t change anything in reality,” Pabst says. Financial institutions such as banks and credit unions had additional processes for providing proof that he could control his mother’s assets or assume decision-making.
Professional help was a godsend. Working with an attorney and financial planner made a big difference for Pabst. Had he known that ahead of time, he says, “I would already have had them on board.”
“The time for building any of these structures — the will, power of attorney, the financial planning — is before you need it,” Pabst says. “Because once that ball starts rolling, it can accelerate faster than you think it will.”
Conversation With Aging Parents
The best time to talk to your parents about sharing information on health decisions, financial affairs and even logistics like account passwords is well before urgent situations arise. “In an optimal, ideal world, it’s when the parent is approaching their later years, is still healthy and able to communicate about these issues and there can be a meaningful discussion,” says Sara Czaja, director of the Center on Aging and Behavioral Research in the Division of Geriatrics and Palliative Care at Weill Cornell Medicine in New York City.
However, it’s not surprising that many families put off these essential conversations until dire need arises. “The reason people don’t speak about these issues before an urgent situation occurs is that it’s not a pleasant topic to talk about,” Czaja says. “You don’t want to think about someone being ill, or injured or out of your life, worst case. Also, these are highly sensitive topics for both parties. For the older adult, because in some ways, it is reminding them of things to come, that perhaps threaten their independence and recognizing that at some point, they may no longer be able to make these kinds of decisions.”
For the adult child, this conversation “reminds them of loss,” Czaja notes. “Also, talking about finances and associated issues is always very difficult.” How people feel about these discussions varies with the nature of the relationship between the parties, she says. “It also has a lot to do with the older adult and child understanding the importance and what the implications are if in fact these conversations do not happen. There are some consequences — things that may happen that people did not intend or wish to happen.”
Transparency is always best when approaching a parent about sharing information, Czaja says. “But there are word choices that one can use in terms of ‘helping to plan for the future’ or ‘plan for the family,'” she adds. “Positive, nonthreatening language should be used. For example: ‘You’ve accomplished a lot in your life. You have these things that are a part of you. Do you have preferences as to what you would want to happen to those things should you no longer be here, or not be able to state those preferences?'”
You can still have these discussions with parents who have some degree of cognitive decline. “People with mild cognitive impairment can still have an understanding of these issues, as can even people with mild dementia,” Czaja says. “People are surprised by what can remain — how they can still have some input.”
Technology can provide a bridge for information-sharing among family members. For example, PRISM (personalized reminder information and social management system) involves easy-to-use software that’s been pilot-tested and vetted for older adults, created by Czaja’s group as part of an National Institutes of Health-funded, multi-university initiative, the Center for Research on Aging and Technology Enhancement (CREATE).
Once commercially available, PRISM could make the internet more accessible to older adults who hesitate to use computers, and provide a way for parents and adult kids to share a screen, go over documents together and make information readily available. For now, she notes, selective-view applications like Zoom can facilitate these parent-child discussions.
Lawyers who specialize in elder care or estate planning help families manage these issues — and it’s best to do so while parents are doing well. “Bring your parents here — or to your chosen estate planning attorney — before your parents lose the capacity,” says attorney Lena Clark, founder of an estate planning, probate and elder law firm in Frederick, Maryland. “”Financial Durable Power of Attorney’ is a document that will govern who’s going to be managing financial affairs.” Other important documents such as wills, living trust and advanced medical directives can also be created or updated.
Having estate documents prepared is infinitely preferable to waiting until a parent develops dementia (or comes down with a severe medical condition like advanced COVID-19 or suffers a life-altering accident). When parents develop dementia, family members can face an unfortunate surprise in terms of their legal rights.
“Potential clients often schedule consultations and they say, ‘Well, my mom has dementia and I just really quickly need a power of attorney or a medical directive, just really something quick, very simple,'” Clark notes. “If the person has dementia, it’s too late. People don’t understand — they’re kind of in denial about how expensive it is and how complicated it’s going to be to get them appointed as guardian. Because it goes through the court at that point.”
It’s important to keep documents updated, Clark points out. “For example, we typically recommend once you have the documents in place, review them annually on your own,” she says. It’s usually recommended to see an estate planning attorney every three to five years to make sure documents — like power of attorney — are still current with any new laws, she adds.
Attorneys can explain key provisions like the “Fiduciary Access to Digital Assets Act” which addresses access for executors and family members to email and website accounts, and other electronically stored assets upon a person’s incapacity or death in most U.S. states.
“Definitely ask your parents if they have documents in place,” Clark recommends. “Talk as a family. Do have that conversation so you know what your parent would want.”
Framework for Families
In light of his own experience, Pabst has created a comprehensive array of checklists to help others plan ahead, anticipate complications and avoid frustration.
If possible, physically get your hands on your parents’:
— Cellphone, and screen lock code, for two-step account access verifications.
— Computer, its login and password.
— Driver’s license.
— Insurance and Medicaid cards.
— Credit and debit cards.
— House keys.
— Car keys.
— Safe-deposit box key.
Know your parents’:
— Email address(es) and password(s).
— Social security number.
— Date of birth.
For account access:
Consider making a new, dedicated Gmail address as your parent. Get access to, and change the logins to the new Gmail address, and the passwords of, online accounts. This is especially critical if your parent is still attempting to access accounts, possibly getting locked out, and possibly having their credentials unsafely written on pieces of paper at their computer.
Also set up online access to accounts, if your parent never did, for:
— Bank accounts.
— Retirement accounts.
— Social Security Administration.
— State income/property tax.
— Life insurance.
— Prescription mail service/local pharmacy.
— Homeowners insurance.
— Auto insurance, AAA.
— Utilities: Electric, gas, cable.
— Phones: landline and mobile.
— Turbo Tax or other tax assistance.
— Doctors’ offices/patient portals.
— Health insurance.
— Homeowners association.
While logged to these accounts, switch to electronic communications and cancel all the snail mail.
Consider hiring these professionals after researching your options:
— Elder/estate attorney.
— Financial planner.
Critical documents to draw up and notarize with a lawyer:
— Durable power of attorney, in the parent’s state of residence (to access their accounts and take care of their home when they can’t).
— Medical advance directive/power of attorney (to tell doctors and hospitals and nursing home staff what to do or not do, and bill you for, when the patient can’t advocate for themselves).
— Living will (if applicable), to have in-hand to enforce their wishes when specific conditions dictate switching from life support to palliative care.
— Will and testament to take executor control of all their accounts, possessions and so forth. (The POA dies with the person.)
— Letter of instruction for burial or cremation, funeral arrangements and so on, or designation of someone authorized to make decisions. When the time comes, get more copies of the death certificate than seems necessary.
— Trusts for protecting their financial estate against probate.
Submit the POA to banks (their forms will usually require an additional notary). Also determine if you’re already a joint account owner. Your parent may have certificates of deposit, savings and stocks you didn’t know about. Have hard copies of relevant documents in your vehicle or carrying case to bring to hospitalizations and appointments.
Critical changes of mailing address if you’re not physically collecting mail at their residence:
— State tax agency.
— Department of Motor Vehicles/Motor Vehicle Administration.
If selling their house:
— Make sure you can locate the deed.
— Hire an agent, stager, deep cleaning service.
— Hire an attorney and/or accountant.
— Arrange a home inspection.
— Make arrangements for services such as trash removal and termite/pest management.
— Count on needing days or weeks to go through their belongings and empty the house, depending on how many hands to help, and how sentimental you are.
Be prepared to deal with neighbors and inquirers. They may be trusted persons who have a spare key and you didn’t know, or they may be the last people whom you want to be aware that the home is unattended.
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Taking Over Affairs for an Aging Parent in Mental Decline originally appeared on usnews.com
Update 03/15/22: This story was previously published at an earlier date and has been updated with new information.