Managing a parent's health care: They say they're fine, but is there a need to worry?

In most cases, managing the health care of an older adult starts slowly. Your parent might be independent and living in their home, and they begin to call you for small tasks such as picking up prescriptions or taking them to medical appointments.

Most, but not all, older adults begin to decline - something that is hard to accept and think about. The decline can result from worsening chronic medical conditions or a fall resulting in a broken bone. The older and frailer someone is, the longer recovery and rehab take. And usually, an older person does not reach their previous level of functioning.

As the adult child of a parent, you may assume that you can speak with doctors, arrange for home care or review medical records. Without legal authority, you will be unable to help in any of these areas. Some health care entities are stricter than others, but you don't want to be in a position where you need to support and can't.

Red flags are warning signs that your parent may be struggling. Recognizing red flags requires a close level of attention. Sometimes your parent won't appreciate this attention, so you may need to be discreet.

Medication mismanagement

You can detect medication issues by knowing what medications your loved one is taking. Look in the medicine cabinet. If you see expired drugs, it could be cause for concern. Does your parent use a medication box? If so, review and reconcile the prescribed mediations with days and times for medications in the box.

Refusing to go to the doctor

If your parent refuses to go to the doctor there could be several causes. Perhaps they don't want bad news. Or they haven't complied with medical directives regarding their health care. The other possibility - your loved one doesn't want to drive to the appointment and can't access telemedicine visits.

Cognitive problems

Approximately 6.5 million older adults in the United States have dementia. The incidence increases with age. Some cognitive problems are associated with medication or medical issues, but most forms of dementia have no cure and get worse over time. If your loved one is showing memory and judgment problems, it is time for an evaluation. With an assessment, you can understand the prognosis and plan for the future.

Mobility issues and falls

One out of four older adults falls every year. Falls are catastrophic for older adults and can result in permanent disability and death. Your parent may deny they fell or tell you they had a fall but minimize the incident. Take note if your loved one has had a fall. One fall predicts another. Falls can be due to several factors, but the loss of mobility, frailty, poor balance and a cluttered home can all contribute.

Driving

Is your parent still driving, and should they be? One of the best ways to determine if your parent should be driving is to go with them in the car. Are they distracted or confused? Do they get lost? Have you noticed new dings on the vehicle?

Considering the delicate nature of these conversations, we have some tips on broaching the subject. But before you embark on these conversations, discuss your concerns with any siblings. Involving them from the beginning will keep everyone on the same page, and when you need them, they will be prepared.

• If the situation isn't an emergency, take your time with these discussions. You don't want your parent to feel pressured or controlled.


• Ask your parent if they need help with anything or if they have immediate concerns. The likely answer will be “no,” so at that point, discuss your concerns - calmly.


• Always be respectful and inclusive. Approach the idea of managing health care as a partnership you will work on together.


• Have some solutions in mind. A health care power of attorney should take priority. Explain that authority is only granted upon their incapacity or directive. They must grant any other health care permissions with a release of information. If your parent needs more help in the home, talk with them about hiring out any tasks.


• Ask a sibling to attend any discussions with you.


• Try and reach a consensus on specific topics. Talk about goals of care and see if you can all agree on at least some of those. Recognize that care goals change over time, so revisit them often.


• Come back another day to continue these discussions. Read the emotional tenor of the room - and if your parent is tired or gets frustrated, end the conversation and move on to something else.


• Sensitive subjects that imply your parent can't manage should always be approached with compassion and empathy.


• Open a discussion about future care options and what their preferences are. Would they consider assisted living or some other senior care?


• Broach the subject of finances. Acknowledge that your parents want as much control as possible over their finances. Offer solutions that honor their need to stay involved but allow you to take over if necessary.

There are two critical documents you need to manage health care for a parent. An experienced estate planning attorney can help ensure the proper execution of these documents.

Health care power of attorney

A health care power of attorney is a legal document that permits an individual to empower another person to make decisions about their medical care. The benefit of talking with your parents about a health care power of attorney is that it allows them to determine the specific medical interventions they do and do not want. If your parent is unconscious or unable to speak for themselves and you are their health care power of attorney, you can advocate and make decisions on their behalf based on their wishes.

Financial power of attorney

Health care entails finances. If your parents cannot manage their health care, it is a good possibility that they will struggle to manage finances. Financial power of attorney documents can be set up to give you immediate authority to manage finances, or at such time your parent cannot do so. The other option is for you and your parent to discuss the different options with an estate planning attorney.

Many adult children have no idea about the extent of their parents' finances. To pay for future care needs, you will want to understand their financial situation. The cost of elder care can be shocking. Talking about this subject honestly and openly will be hard but necessary. This could be an excellent time to find out what your parents want if they can't remain in their home and how to pay for it.

Having legal authority to manage a person's health care is the first step. The next part is learning how to be an effective health care advocate. Our suggestions:

• Complete a review of all health care

Health care is complicated, and your loved one could have several specialists in addition to their primary care physician. Find the best method to track different doctors, contact information, medications and diagnoses. Some people prefer an online way of keeping this information safe. Share with other appropriate family members.

• Review your parent's health insurance

It is not unusual for adult children to not understand how Medicare, Medicare Advantage and Medicaid work. Adult children often don't even know their parent's insurance. Please educate yourself about the different parts of Medicare and what they cover and don't. Most people think Medicare covers more than it does, and Medicare Advantage plans have restrictions on providers.

• Consider a geriatric physician

If your loved one has a geriatric physician that they like, great. But, many older adults have had the same primary care physician for years who they are very attached to. That doesn't necessarily mean that their doctor is not good, but you should attend all appointments to evaluate their expertise. If your parent has complicated medical problems requiring detailed and time-intensive care, make sure their doctor is up to the task. Many geriatric practices have nurse case managers and other support services for older adults.

• Advocate without fear

To truly advocate effectively, you must be willing to ask any and all questions. Your time will be limited when you are in a doctor's office with a parent. Don't let that stop you from asking questions you have about your loved one's care. Make a list in advance of your visit with any concerns. Find out who is responsible for any follow-up.

• Accept that health care is fragmented

Managing a parent's health care will be time-consuming and frustrating because health care is generally fragmented. Once you accept this fact rather than fight it, you will be less stressed.

• Ask your siblings for help

If you are the health care power of attorney and primary caregiver, you don't have to do everything yourself. Ask your siblings for help and engage them in making decisions. A team is almost always better than one person.

• Go to doctor's visits

To the extent possible, try and go to all doctor's appointments. Otherwise, you will be spending time later trying to access information. If your parents have an online medical record, request proxy access. Reviewing the chart online will significantly help keep track of changes and communicate with providers.

Support resources for managing health care for an older adult will depend on your situation. But here are some essential resources to help you support your loved one:

Medication management systems

There are scores of medication management systems; some are automatic locked pill dispensers. All medication management systems have value as long as your loved one can understand how they work. Even medication reminders may not work with someone with memory problems. In some states, private caregivers can dispense medications; in others, they can't.

Online time management and calendar programs

Without some system, communicating and keeping track of who is doing what can get cumbersome. There are many different management programs out there you will want to review and see what might work best for you. Some families use Google calendar to keep track of visits and scheduled appointments.

Consider a geriatric care manager

Yes, geriatric care managers can be expensive, but if you or your loved one can afford one, they can be invaluable. A good care manager has an excellent grasp of local resources and can monitor a parent's condition and make reports. Most care managers are very flexible with their time. And if you want to go out of town? A geriatric care manager can be there to respond to any emergencies.

Emergency Response System (ERS)

An ERS is a pendant that an individual wears that will automatically call 911 in case of a fall. Most now have GPS tracking systems as well. ERSs save lives, but the tricky part is getting someone to wear them 24/7. Encourage your loved one to try an ERS.

With planning, compassion and open communication, you can manage your parent's health care. The earlier you start, the more smoothly the journey will go.