Welcome to “It’s My Turn To Care.” We know the challenges you face caring for someone with dementia. That's why each week we bring you tips, strategies, and most of all, support, as you navigate your role as caregiver. Let's get started. [00:15.6]
Dave: Hello, and welcome to It’s My Turn To Care: Secrets for the Dementia Caregiver. My name is Dave Parks and I'm the owner of Home Care Assistance, and I'm also a certified senior advisor and I'm the host of your program today, and today we have Tena Burrell.
Tena has been in the financial services world for a long time. Over 30 years, she has worked to help individuals and families plan for their financial future, specializing in the fields of retirement and estate planning, and Ms. Burrell educates clients on how to help preserve their financial assets while maintaining a sustainable standard of living. [01:08.4]
As the owner of Financial & Estate Planning Services, Tena takes her many years of experience and offers sound financial alternatives to create solutions based on the needs of each individual client. We're so excited to have her because, no matter what we do, the money question always comes up and how to pay for services and what to do to plan for that.
It's great to have Tena with us and we welcome you to the program.
Tena: Thank you.
Dave: Great. Let's jump right into it. One of the things that we get a lot from clients is how am I going to pay for this? How do I plan for this? Why is it so important to plan?
Tena: That's a great question, Dave, and the main answer that is to plan ahead, not that we don't have some idea of what we're thinking we would do, but most people don't have a plan ahead of time and then they end up in what I call “hair on fire” planning mode. [02:15.1]
Dave: Sure.
Tena: The most important thing is to take inventory to find out, if you're caring for a loved one, what they've already got, what they've managed to amass, as far as savings, their sources of income, insurance or investments that they may already have, who are their financial professionals that they work with now, do they have one? Have they ever had one? Do they have an attorney? Have they had a CPA? Which then also leads into some of the legal documents. But what you need to find out is where the money is, where it's going to come from and just plan ahead, so it's a lot less stressful for both the caregiver and the care recipient has some input, some say into how they would want their spent if we're planning ahead of time, rather than after the fact, last minute planning. [03:05.1]
Dave: Sure. A lot of this probably has to do with how do you want to live, right?
Tena: Exactly.
Tena: So, where do you want to live? Do you want to stay in your home? Do you want to live in an assisted living? Do you want to stay at home as long as possible? And like you kind of touched on, it's important for your loved ones to know what your wishes are, because if they don't, then they may end up making decisions that you may not necessarily agree with.
Tena: Right, that, and then, or you'll have them argue amongst themselves and it becomes a real battle for everyone. What I see with a lot of the families I’ve worked with over the years is that that ends up being a very stressful battle if one sibling, one child wants one thing, another one was another, so it makes life a lot harder than it needs to be. I myself took care of my immediate family for over 30 years. That's what really got me involved with the area agency on aging and doing caregiver support groups or facilitating caregiver education, which I do locally at a couple of community colleges. [04:10.8]
The most important thing I tell folks is to plan ahead, so that not only you can say, here's what I would like to do, I would like to stay at home, for example—who doesn't want to stay at home, more than likely—but which home do I want to stay in? My own? Would I be willing to live with one of my adult children? Would I not really want to do that? Would I prefer assisted living? And whatever that person's preference is, we need to find out if they have the assets or the means to be able to do so, and/or if there are things we can do now that will change that. There's a lot of times we can plan ahead and find hidden money that people have in old life insurance policies or things of that nature that we don't even know about.
Sometimes people will call me and say, My parents are elderly and they don't know and how can I find out, rather than calling any and every company that you think they may have ever had a policy with and saying Jane Doe's name and her social security number. It's so much easier if we can get some information upfront. [05:10.9]
Dave: Yeah, that's so real. That happened to me with my father-in-law. He wanted me to help him. He was probably in his late-seventies, if not in his eighties, and he wanted me to help him kind of get all his ducks in a row. We would sit down and with several nights of this and after he said, “Well, that's all I have,” I said, “Are you sure? Is there anything else?” and I probably asked that and he came out with another account five different times.
Anyway, financial and legal kind of overlap a little bit when it comes to sort of planning for your care and for your future. We have had an attorney on it, but talk a little bit about the essential estate planning documents you need. [05:58.2]
Tena: Sure, and without being redundant of the attorneys. I work with a lot of people before they ever go to their attorneys. I start prepping them and getting them ready to go to the attorney, so by the time they actually go to an attorney, not only do they save time which is saving money, they've got the people in line in mind that they want to do different jobs.
You pick one person maybe for a healthcare power of attorney, that's the person who's going to communicate with the doctors to speak on your behalf, maybe goes to the doctors with you now or communicates with your home health care agency or whomever you're using. Then there's the other person who may be really good with money technically, but they don't really want to go or have the time to go to the doctors on a regular basis.
I tell folks, it doesn't have to be the same person. You can designate one person as your medical power of attorney and you can designate another person as your financial power of attorney, or the technical person or the money person, and a lot of times that's a great relief to especially my seniors, because they don't want to put all the burden on one child or they want everybody feel like they're getting their fair share being part of the plan, which is great. [07:06.5]
Dave: Yeah. I think the other benefit is you want more than one person, if you can, making the decisions.
Tena: Absolutely.
Dave: If you have a different medical and a different financial, they can't help but to have to discuss what's best.
Tena: Right, the attorneys will often also tell people don't make a co-trustee or a co-executor or co-financial power of attorney. Because we have two people listed as co, they have to agree on everything.
Dave: Right.
Tena: It's better to separate out those duties because -
Dave: That’s a good point.
Tena: - then we don't want to have them arguing over who's going to make that final decision if especially there's any animosity amongst the siblings, and unfortunately that happens a lot.
Dave: Sure. Talk a little bit about how you kind of keep all this organized.
Tena: Keeping it organized is essential, in that we want to have our documents, our legal documents, all of our medical documents in a place where your family can find them. [08:02.8]
If something happened to me tomorrow, I have all my documents in a safe, but the person who is my executor has their copies. Matter of fact, they have the original copies of my will, because at that point, they're the ones who's going to need the original, not me.
Medical power of attorneys, financial power of attorneys, since those end with our life, they should be in the possession of the person who needs them when you become incapacitated. I believe in giving the originals to those folks and keeping copies for everyone else, including myself, because, again, if that's needed the person who's going to need that original document is the one who should hold it. Banks and financial institutions often will want to see the original and, unfortunately, they require that. Some banks won't even change a document without the original, even though they're just going to scan it and send it through the legal department.
Dave: Right.
Tena: And so it is good for the person who you have trusted with that duty to have the original and you keep your copy. If you ever need that original, obviously you could get it back from them. [09:02.7]
But then, again, keeping it organized in a file. The old fashioned white paper is great. I mean, that's what a lot of us still do. It's great to have things digital on the computer and it's great if it's backed up, especially if the computer crashes, and maybe one day in the future we will have a little chip in our body that we can carry around, but we're not there yet.
Dave: Yeah, I'm not really looking forward to that.
Tena: Yeah, the fire and police department often tell groups when they go in and speak that have a fireproof safe at home, have it on the ground floor, because if you do have a two-story house and everything, God forbid, catches on fire, it's going to end up on the ground floor and you want it where it's not going to be as damaged or easy to access.
Dave: Yeah, that’s a good point. I never thought about that.
Tena: Yeah. They used to tell them back in the old days, and a lot of people may remember this, they would tell him to keep it in the refrigerator because it was a fireproof safe deposit box. Unfortunately, we don't keep things maybe as clean or as accessible in the refrigerator, so the old lifeline things while alive, keeping something on your refrigerator that the EMTs would find if they come in. [10:08.7]
Dave: Sure.
Tena: It can still be a challenge because if it gets moved. My brother used to have that system and it was always a challenge for me to keep it placed where it wouldn't get moved or whatever, and I actually had a fireman or EMT telling me one day, Why don't you just put your power of attorney, your medical power of attorney in a frame and put it on the wall? And that was just brilliant idea.
Dave: Yeah, it's so important to keep organized, just in general, but it also helps speed up the process of starting care. If you're in a medical or even a nonmedical situation, it's a lot easier to get started if you have all your documents and you're acting on the behalf of someone in some cases, and if you're at the doctor, you don't have to scurry home or scurry to some safe deposit box that may be closed at night at the bank or whatever the case may be. Having it accessible and organized can actually help the overall care that you get. [11:08.2]
Tena: Absolutely.
Dave: This is something that I’ve been thinking about. Talk about the importance of knowing what your loved one really wants? That is very important, Dave, and I know that you all do focus on that a lot when you're working with families. It's a sad situation when the parents become ill, or I’ll say anybody becomes ill, and no one really knew what their desires were, and so everyone feels awkward, stressed. It's just great to have those conversations ahead of time, so that we know what people want.
Having our medical power of attorney and our advanced directives prepared that you have, it kind of puts a person in a position where they have to talk about that and those are really actually free documents available. The area agency on aging has them on their website to download for free that attorneys have written and donated. Attorneys generally write those when they write new trust or will documents, but they are available for free. [12:08.4]
So, if you're having a difficult time getting someone to tell you what they think their desires would be or they don't want to put it in writing, maybe just get them talking about it that way, again, because it speeds up the care. We know what they want. We know what they would have wanted in a given situation where it's a hair on fire, last minute kind of planning.
A lot of times people don't necessarily get sick slowly. If something happens, whether it's a stroke or a heart attack, it throws us into that fast track, so it's always smart to have had that conversation, even with people under 60. I’ve heard so many times people say someone over 60 should have this conversation. I personally believe anybody should have that conversation if they're an adult.
Dave: Right, and to me, you need to have the conversation more than once because your wishes could change.
Tena: Right, absolutely. [12:58.1]
Dave: As medicine changes, science changes, you may change your mind about a decision you made before. I think about when my wife and I, it was probably 10 years ago, we went through all this, all the documents that we've been talking about, and now I'm thinking we probably need to revisit that because I don't exactly remember what I said in my own will, so I might want to…
Tena: Right, and as we grow older, we do change our attitudes about things in general, and medical science keeping everyone alive longer, we have to think about what we'd want with those changes.
Also, that brings up a good point about financials. I mean, I meet with people at least once a year and one of the first topics of discussion is beneficiary arrangements. Do we need to change those? Do we need to look at those and update them? Because family dynamics change. People get divorced. People get married. We have whatever happens, happens, and it's going to change sometimes who we might choose for that caregiver.
Dave: Right, family dynamics are, we know, a separate podcast on family dynamics, so a lot of moving parts here. What are your thoughts on seeking professional advice? [14:06.1]
Tena: I believe that it's always a good idea to at least interview professionals to kind of see what the recommendations are because they keep current. I keep current with the financial sector. The attorneys keep current with the estate, CPAs keep current with the tax. I'm kind of forced to keep current with all three of those categories, but not to the detail that they do, but the fact that, for example, Texas updated the financial power of attorney document a couple years ago, if yours is 10 years old, you might need to have that reviewed.
The supervising finances while one still can. I mean, I have multiple clients that I can give examples of, but one who is my godmother up in Tulsa, her adult sons are really in charge, but I'm the backup just because I'm so close the family. One of the sons who was more hands-on passed away from cancer last year and he was in his forties, so the other son who's long distance was thrust into that position. [15:01.8]
I had never been a hands-on caregiver, let alone remotely or long distance, so I've kind of helped him by helping him, taking him by the hand and teaching him the steps. But it got to the point where she was getting hacked on her bank account every time she logged into the bank account to do her finances. I told him, “It's really time that you get more familiar with her bank accounts, take over auto pay, bill pay, because of the fact that was just leading to so many other problems,” so having those financial conversations ahead of time, sometimes is difficult.
I either have clients, and there one or two ways, that they either share everything with their adult children or their caregivers, or they're going to say nothing. They're going to share nothing. When you have an awkward situation and it's like Mom and Dad really don't want to tell us what they got, what they've had, maybe you need to seek a financial professional to help get that out there or a legal professional or both. That's one way. If you know who their CPA and or financial people are, you can get their assistance. [16:02.5]
Dave: Sure. One thing I thought about was when we were talking about what people want, it could be different and this is why I say you need to have the conversation more than once. You could want one thing while your spouse is still living, right?
Tena: Absolutely.
Dave: You may want something else if you survive your spouse.
Tena: Absolutely.
Dave: It could be as simple as I want to live at home while my spouse is living, but I don't want to live by myself, so I want to move if I outlive my spouse, so that kind of conversation.
Tena: And it does change. Like you said, a lot of people think that always maybe you want to be at home, but then when they lose a spouse a few years later, they kind of quickly find out, This may be I'm not getting enough social interaction. I want to be around other people, and even if they just go to a 55-plus community, it's not even well before they need any kind of assisted living. I've seen that happen with several of my widowed lady clients and it probably will improve their longevity because they are socializing amongst other people. I know you all work a lot with the cognitive skills. That’s really important. [17:06.3]
Dave: Yeah, there are different ways to get socialization, but I guess my only point is that your wishes could very well change.
Tena: Absolutely.
Dave: You may be in a community with your spouse and you're like, I don't want to be here by myself, so I want to move back home, whatever the case may be.
Tena: Right.
Dave: Great. Let's talk a little bit about this. What we may do is split this into two shows if that's okay with you, Tena. Let's talk a little bit about there's some public benefits out there, some things that the government has helped us with. Talk a little bit about those kinds of programs.
Tena: There are actually more than people do realize and, again, that may be something to come back and visit on a second show to hit the high points. Most of us realize we have Medicare once we turn 65. People often get the term Medicare and Medicaid because they really don't know what Medicaid is, and I just explain to folks that Medicaid is for the lower income folks who just really don't have assets to pay for their own care. [17:59.2]
If a person has more than $4,000 in net assets, period, I mean, that includes your home, everything, bank accounts, then you probably would not qualify for Medicaid without some pre-planning and doing some legal structure planning, even maybe having to spend down or get rid of some assets.
That's something you want to look at way in advance if you think you might even be interested in that.
Now, the disadvantage to Medicaid is being a government program that is meant for low-income folks, it's not going to be the best care. You're not going to have the best quality or number of dollars spent because Medicaid is actually more broke than the whole social security system. It's very underfunded and continues to be. When you hear about Medicaid for children, that's a whole different program than Medicaid for seniors or long-term care. That's one I spend more time educating people and clarifying misconceptions on than any other. [18:58.4]
If there are retired or a veteran, the VA has for veterans some nice programs and there are several there that we could spend quite a bit of time on, but anybody who is basically a veteran in an active military time of war is eligible for some type of additional funding and that's a great, great benefit.
Those are the two big ones that jump out, but, again, locally, again with the area agency on aging, there's some best kept secrets. We have several charities here in the North Central Texas area that do a lot of work with seniors that people may not know about unless they come to a professional or come to a charitable organization, whether it be Catholic charities or something like that that tells them about mid-city care, of course.
The area agency on aging has had the 211 national hotline for a very long time and it's a great resource for people to find out about those things, but working with either a legal or financial professional, or someone like yourself who knows about the VA benefits gets them to that next step. The VA office is there. They're there to help us and it's wonderful. They don't charge a fee, but they also sometimes are overwhelmed. [20:10.1]
Dave: Yeah, there's no question about that that they are overwhelmed.
What I'd like to do is,4 first of all, thank you, Tena, for coming on It’s My Turn To Care: Secrets for the Dementia Caregiver. You have so much good information. What I'd like to do is have you come on the show next week and we will talk some more about the financial issues and come up with some more tips and strategies for our listeners.
But I want to thank you for listening to It's My Turn To Care. This is Dave Parks with Home Care Assistance. Please visit our website HomeCareAssistanceFortWorth.com or call (817) 349-7599 if we can be of service. I do apologize, I want to see, Tena, if people need to reach out to you, how would they contact you? [21:04.3]
Tena: Thank you, Dave, for asking. They can go to my website and I keep it very simple. It's my name spelled out, T-E-N-A-B-U-R-R-E-L-L [dot] com,
TenaBurrell.com, or they can reach me toll free at (800) 536-9996.
Dave: Great. All right, thanks again for listening and we'll talk to y'all next week.
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