Sibling dynamics among children play into how well those siblings will work together later in life.
At some point, these same children will be in a position to work together to help manage your care. They already are (or will be) watching how you work through care navigation with your own siblings.
Itâs hard to imagine that future I know, but as Psychologist Dr. Albers states, âRole modeling is one of the most powerful and effective ways to teach your children how to get along with their siblings.â
Itâs a complex topic without a “one size fits allâ solution, but this article from the Cleveland Clinic outlines 10 tips for dealing with sibling rivalry. A few of the main points include:
Create a cooperative environment
Celebrate individuality
Treat kids fairly, not equally
Give children problem-solving tools
Make discipline private
Have a family meeting
Weâve presented how powerful family meetings can be to manage care navigation for the older adults in your family circle. Imagine how useful it would be to have family meetings already a practiced habit from childhood!
May you find joy in loving one another well in and outside of your family meetings!
Conversations between siblings about care for an older adult are layered with emotion and just might have lasting impacts on the family for years to come.
The truth is that most siblings donât talk about care management roles until it is essential. Nobody wants to have a stressful conversation in the hospital corridor. We want you to be prepared to calmly navigate care for your parents or in-laws.
Weâve highlighted some of the common sibling care controversies and have tools to move forward with purposeful and peace seeking care conversations.
My Parents are Healthy…
If you have healthy older adults in your care circle, why should you make a plan with siblings now? Let me illustrate why this is so important with a story.
Adamâs perfectly healthy dad, George, had a fall one afternoon where he hit his head so hard he had a brain injury resulting in him being unable to speak clearly or make decisions. In a matter of minutes, Adam went from âmy dad is perfectly healthyâ to trying to figure out if he or his sister was the healthcare proxy. He didnât know if his dad had his wishes defined and where in the world that paperwork was, if it existed at all. His sister thought her dad had asked her to be the healthcare proxy, but Adam said his dad had talked to him about it over golf one day. His sister was furious with Adam over how he was directing the care for their father when she thought it was her role, but Adam felt he was just trying to do his best in a terrifying and chaotic situation. Neither of them thought the other person was in the right role nor did they know what their dad would want, except for them not to be fighting.
You may be thrust very suddenly into figuring out care for an older adult. Are there other family members involved also? If so, there are three common barriers to setting up a successful care team: personal agendas, childhood roles and division of responsibilities.
Challenge: Personal Agendas
At work, we clearly define project goals at the onset, so itâs clear when they’ve been achieved. While a caregiving journey is likely not as quantifiable as your work projects, itâs just as important to define the overarching goals.
Solution: Establishing common goals
Among siblings, start your conversation with your common goals.
We all want to respect our older adults’ wishes and needs as much as possible.
We donât want angst or division between us during this time or for the years following.
Once we agree on these basic goals, itâs much easier to sift care decisions and strategies. We recommend restating the common goals whenever care planning is being done, particularly when bigger decisions are being made.
Challenge: Childhood Roles
Let’s say you and your siblings have defined the key goals, but that doesnât really make up for the fact that your brother has always been the (insert primary trait from childhood) one and your sister will likely be (insert primary trait from childhood). The roles your siblings played in your family are decades old. Are you assuming that they are the same people they were in childhood? You have likely evolved past those early stereotypes or roles and want your siblings to see you for who you are today, many years later.
Solution: Recognize current strengths
Instead of dragging those old assumptions into this season, can you put yourself in a neutral, curious and even grace-filled posture when it comes to who your siblings are and what they are capable of? We all have different strengths. Each sibling has an opportunity to help in a way that fits their strengths and giftings. Thatâs a beautiful thing.
Challenge: Whatâs âfairâ?
When you and your siblings were young, there were likely feelings of what was âfairâ between you. Remember the heated argument of who got the piece of cake with the big green frosting-filled flower on it? Now that everyone is older you already know that most of life isnât âfairâ, but in addition to that, you and your siblingâs lives are significantly more complicated as there are geographic locations, spouses, kids, jobs, health and individual finances that factor in for each person. All of that wasnât a factor when you were jockeying for the piece of cake with the green frosting-filled flower on it. The notion of siblings each covering their âfair shareâ of care navigation just isnât realistic.
Solution: Accept imbalance and ask for or offer support
The truth is that usually the majority of the caregiving responsibilities fall on one or two peopleâs shoulders. Itâs helpful to accept that and let go of whatâs âfairâ. The individual taking on the bulk of the care can take time to define how others can help; other family members can support in the ways requested.
The power of the family meeting
A well-prepared family meeting creates a way forward.
To help you suggest or run a family care meeting, we have two great options:
Enlist the support of your Care Advisor to facilitate a family meeting. Having an unbiased third party involved can be a way to reach a decision especially if sibling relations are complex or the necessary decisions are weighty.
You may not be able to get absolutely everything in place, but whatever steps you take, however small, can ease the stress of managing care for the older adults in your family circle.
Are your elderly parents or in-laws on the right Medicare plan?
Medicareâs open enrollment (aka Annual Election Period) is from October 15th to December 7th. The last change on or before Dec. 7th will take effect on Jan 1st 2025.
What current Medicare recipients should do
Should current Medicare recipients look at their policy? Medicare says: It depends on the type of plan currently in place.
If the plan in place is Original Medicare (aka Part A and Part B) plus a supplemental plan (often called a Medigap) and the recipient is happy with the coverage, a change doesnât need to be made.
If the plan in place is Part C (aka Medicare Advantage) or Part D, the recipient should review all the coverage options (even if they are happy with the current coverage) because plans change their costs and benefits every year. To do that, read the Annual Notice of Change (ANOC), which should have been received by September 30. The ANOC lists the changes in the plan, such as the premium and copays, and will compare the benefits in 2024 with those in 2025.
Do some homework before switching to a Medicare Advantage plan
Currently, 54% of Medicare recipients have a Medicare Advantage plan, but not everyone is happy about it. The Pros and Cons of Medicare Advantage by Fortune Well outlines some significant âconsâ such as:
According to a KFF study in 2022, âtraditional Medicareâ outperformed Medicare Advantage in receiving care in the highest-rated hospitals for cancer care or in the highest-quality skilled nursing facilities and home health agencies.
The U.S. Health and Human Services Inspector General reports found âwidespread and persistent problems related to denials of care and payment,â related to the prior authorization rules specific to Medicare Advantage plans.
Medicare Advantage plans are permitted to limit their provider networks, the size of which can vary considerably for both physicians and hospitals, depending on the plan and the county where it is offered.
For those turning 65: how to avoid Medicare penalties
Recipients are eligible for initial enrollment in Medicare during a 7-month window, which includes:
3 months before a 65th birthday,
during their birthday month and
3 months after their birthday month.
According to Medicare, the best way to enroll in a new plan is to call 1-800-MEDICARE (1-800-633-4227). Enrolling in a new plan directly through Medicare is the best way to be protected if there are problems with the enrollment. Medicare suggests that the recipient take notes regarding everything about the enrollment conversation including the date, the representative spoken with and any outcomes or next steps.
If one doesn’t sign up during the Initial Enrollment period, there can be late enrollment penalties for Parts A, B and D unless the recipient has other coverage thatâs similar in value to Medicare (like from an employer.) They also may have to pay a late enrollment penalty.
Late enrollment penalties:
Are added to the monthly premium.
Are not a one-time late fee.
Are usually charged for as long as they have that type of coverage (for most people, thatâs a lifetime penalty). The Part A penalty is different.
Go up the longer they wait to sign up â theyâre based on how long they go without coverage similar to Medicare.
More information about late enrollment penalties can be found on this Medicare page.
How do I know what Medicare plan is already in place?
You can find this information a few different ways:
Look at the recipientâs Medicare card, as this shows: If they have Medicare Part A (listed as HOSPITAL), Part B (listed as MEDICAL), or both and the date the coverage began. With the Medicare number on the card, you can follow the steps to find more information and log into the on-line account here.
Call the program at 1-800-MEDICARE (1-800-633-4227). You will need the recipient on the phone and/or their permission.
Check their medicare.gov account which requires access to their username and password. You will also need their zip code, Medicare number, name, date of birth, and the effective date for the Medicare coverage.
If you have access, sign in to their Social Security account and view the benefit verification letter.
Want help making sense of all the parts and plans?
This two minute video from Medicare provides a helpful summary of what is covered by the A, B, C & D parts of Medicare.
Unbiased guidance on Medicare plans
The State Health Insurance Program (SHIP) provides free and unbiased counseling advice about Medicare programs. The SHIP site has a search by state feature to determine the contact information for your statewide resource.
Alternatively, the National Council on Agingâs Medicare Standards of Excellence list can be used to find agents and brokers working for the recipient’s best interest.
As always, a Ways & Wane Care Advisor is available to support you with navigating care needs including Medicare.
IMPORTANT: By consuming this information, you acknowledge and agree to assume the risk of any injury or harm that may result to any person resulting in whole or in part from actions or inactions and waive all claims against Ways & Wane, together with its subsidiaries, affiliates, officers, directors, agents, employees, attorneys, consultants, or advisors except those arising out of any gross negligence or wanton misconduct of Ways & Wane.
Medicare will cover the cost of momâs housing and care.
False.
Itâs a fairly common misconception that Medicare will cover the cost of housing for older adults, but this is not the case. Medicare will cover up to 100 days a year in a nursing home, but only after a qualifying hospital stay. Particularly since housing prices and living costs are expected to continue to rise, a viable housing plan is more important than ever before.
Most funding for the housing and care of older adults comes from these sources:
The sale or rental income of their home
Retirement income such as a pension or investment account withdrawals
Social Security benefits. According to the Center on Budget and Policy Priorities, in 2022, retired workers received an average of $1,669 per month in Social Security benefits
The fact is that for most older adults in the United States, their available funds do not adequately cover the cost of housing and necessary expenses. Currently, more than 15 million older adults are âeconomically insecure,â meaning they live at or below 200% of the federal poverty level ($27,180 per year for a single person in 2022), according to the National Council on Aging. In fact, by 2030 there will be about 72 million adults over the age of 65 with more older adults expected to enter the federal poverty level than ever before.
Budgeting Tools for Senior Housing
Are you helping an older adult to plan ahead or stepping in to help manage a budget for housing and care? There are two free resources to help in the budget planning process:
This free Retirement Planner Worksheet is for individuals ages 50-70 and does not require identifying information.
If the expected income from Social Security is unknown, you can get an estimate of the expected benefit payout from the Social Security website.
Creative Senior Housing Options
Itâs clear that affordable housing options and creative solutions are much needed to address the needs of economically insecure older adults. Some housing solutions include:
An Accessory Dwelling Unit which can be added to an existing property. Detailed information about ADUs can be found in our article HERE.Â
Manufactured home communities for 55+ can be another more affordable option. The home itself is owned, while the land in which it sits is leased. Care should be taken to understand the expected increases for the cost of the land lease.
Senior apartment complexes offer independent living units, sometimes with common use areas and services. The cost of renting is usually less than the cost to maintain a home and cover property taxes, upkeep and repairs.
The United States Department of Housing and Urban Development (HUD) offers affordable public housing apartments and single-family homes for older adults in need. The two programs which offer the most help to older adults are HUDâs Section 202 Affordable Senior Housing and HUDâs Housing Voucher Program
The Low Income Housing Tax Credit (LIHTC) Program does not provide housing subsidies, but tax incentives to encourage developers to create affordable housing. These tax credits are provided to each state based on population and are distributed to the stateâs designated tax credit allocating agency.
Both HUD programs and the LIHTC have specific processes and requirements to apply. Unfortunately, they can be time-consuming and confusing to navigate. The demand for subsidized housing is already significant and is only going to increase. So while there are long waitlists, itâs wise to begin the process of applying, even if it means paying an application fee.
For a recent client, our Care Advisors found an independent senior apartment complex that also provided transportation, meals and housekeeping and best of all would allow their mom to be within 5 miles of her daughter. For another client who needed an affordable apartment for their mother that would be close by, we narrowed 35 options to four affordable options, two of which were available immediately. Since two were income-contingent, we provided the direct links to the applications, the fees and estimated wait list time.
If you were to ask your 4 year old if you can live with them when they grow up, theyâd likely reply with an enthusiastic âI wanna always live with you; I never wanna live in another place from you!â.
Ask them again when they are 35 and their answer may be different.
Maybe youâll choose to live with your adult child, but it might be nice if you have other choices too. Planning for affordable housing before you are the older adult is something that cannot start too soon.
Retirement Calculator
Do a quick calculation to see if living with your kids will be optional. Without putting in identifying information or creating an account, Dave Ramseyâs retirement calculator will show an estimate of your retirement savings. It will even show you what you can save if you skip the daily coffee purchase, but you donât actually have to look directly at that number.
Compound Interest Example
According to AARPâs retirement planning article, âthe earlier you start saving for retirement, the better off youâll be. If you start putting $5,000 a year into an IRA at age 30, youâll have about $669,400 at age 70, assuming you earn 5 percent a year. If you start at age 50, youâll have $186,860. Although itâs never too late to start saving, itâs a lot easier if you start early.â
And as a backup plan, you could always ask your four-year-old to put the âyou can always live with meâ in writing, especially if you plan on continuing your daily Starbucks habit.
Is the older adult you love prepared for 26 hours in an ER? You think that number was a typo. No, it’s called ER boarding and itâs an all too common problem.
ER boarding describes a situation where the doctor has determined that a patient needs to be admitted, but the patient ends up waiting for hours (sometimes more than 24 hours) in the ER perhaps on a gurney in a hallway. Shockingly, the patient may not receive food or water or get help to the bathroom. Itâs estimated that older adults account for about 30-50% of those who end up boarded in the ER. According to KFF Health News, physicians who staff emergency rooms say the problem is as bad as itâs ever been â even worse than during the first years of the pandemic.
Patient Need May Not Match Hospital Priority
Zikry of UCLA Health described part of the challenge as the fact that, âERs are designed to handle crises and stabilize patients, not to âtake care of patients who weâve already decided need to be admitted to the hospital.â The barrier is in part due to a shortage of beds in the hospital, some of which are held for patients undergoing lucrative surgeries or procedures.
In case you think this is a small or rural hospital problem, Massachusetts General Hospital in Boston, reported that as of September 2023, patients admitted to the hospital spent a median of 14 hours in the ER and 26% spent more than 24 hours.
The result of an older adult being in an ER boarding situation can cause a cascading effect to whatever the new emergency was. The compounding impact of the chaotic environment, limited food and water, minimal care and (potentially) skipped prescriptions can be life changing.
Five Emergency Room Pro Tips
These five ER tips can help increase the odds that the older adult gets the care they need:
Physician Calls Ahead. If possible, have the older adultâs Primary Care Physician call ahead to the ER to alert them of the older adultâs expected arrival and current medical situation and/or history.
Go With the Older Adult. Donât let an older adult go to the ER alone. They need someone to be there to advocate well for them. (Note: the best advocate may not be their partner, who if they are also an older adult, may not do well both physically and/or mentally.)
Pack a Go Bag. Bring the following items (for both the older adult and family advocate):
a list of the older adultâs medications and (ideally) the medications themselves
glasses and/or hearing aids
water bottles
things to pass the time like a magazine or deck of cards
headphones, ear plugs, eye masks
charging cords
food (not just snacks) to eat
medications plus over the counter pain relief
a small overnight bag with toiletry kit
change of clothes
Advocate for Admission. If discharging the older adult from the ER is being discussed, but you believe an admission is more appropriate, you can use language like, âI believe this would be a premature (or negligent) discharge and would like it documented that Iâve expressed this.â This language may be enough to generate a more thorough care response. The Forbes Advisor article titled, What is an Unsafe Discharge from the Hospital? provides more information about this topic.
Communicate Limitations of Living Situation. So a safe and responsible discharge plan can be made, communicate the details of the older adultâs living situation to the staff (e.g. mobility barriers like stairs in the home, who is able to assist with in-home care and what their capabilities are, transportation limitations, etc.). If the current living situation is no longer able to meet their current care needs, make sure that is abundantly clear so that an alternate plan can be made.
A trip to the ER for the older adults isnât something you want to think about. But being prepared and knowing how to be a good medical advocate can make a tremendous difference.
The American Heart Association estimates that 100,000 to 200,000 lives of adults and children could be saved each year if CPR were performed early enough. Particularly with the increase in water-related activities during the summer, having updated CPR can make all the difference. The Red Cross offers on-line, (work at your own pace) CPR classes for as low as $37.00. Thereâs no better time than the present to get trained or update your skills.
Iâll always remember the voicemail I received from my daycare provider with the ambulance siren getting louder and louder in the background and then the sound of the EMTs voices. Itâs every parentâs nightmareâthankfully it was just a fever-related seizure.
The last thing any parent wants to think about is an emergency room trip for their child, especially if they are being sent to the ER directly from their daycare provider. Knowing some of what to expect in that situation can be empowering.
When does daycare call 911?
A daycare centerâs plan likely follows these guidelines:
Staff is trained to recognize signs and symptoms of conditions that require immediate medical attention.
Staff calls 911 immediately upon recognizing signs and symptoms that require immediate medical attention.
Staff calls the childâs parent/guardian immediately after calling 911 to inform them of the childâs symptoms and where they will be transported for medical care.
Staff provides first aid as trained in an approved First Aid training course until emergency personnel arrive.
Staff takes the childâs emergency medical information form(s) with them to the hospital and remains with the child until a parent arrives.
Each daycare should have both the hospital (or other source of health care to be used) and the method of transportation defined in case of an emergency.
For obvious reasons, a home-based daycare with one provider does not allow the provider to accompany the child in the ambulance.
Ask your daycare: what is your protocol if my child needs to go to the hospital? How do you train staff on that protocol? Understanding the protocol also allows you to confirm a preferred hospital, should you have one.
Note: This information is intended for situations where the older adult has the cognitive ability to make clear decisions for themselves.
Depending on the perspective of the adult child or the older adult, a paid in-home caregiver can be a fantastic idea or one to be avoided at all costs. There are legitimate reasons for reluctance and yet practical steps to help introduce a professional in-home caregiver.
Why an older adult may not want an in-home caregiver
Going from being an independent person to one that needs help Is hard. It can bring up complex feelings that touch on the core of oneâs identity. In fact, most older adults initially reject the idea of help from a caregiver. Some of the reasons older adults decline in-home help may include:
A sense of obligation to entertain or host the caregiver
Hurt that âfamily doesnât want to take care of themâ
Distress that accepting care makes them seem vulnerable
A desire to remain in control, and not wanting someone to come in and âtake overâ
Not wanting a âstrangerâ in the home
Feelings of shame or embarrassment by the need to rely on someone else
Setting up the conversation
Start by asking:
Did you have the responsibility of taking care of your parents?
If so, what was the experience like for you?
Did you have to make any difficult decisions?
Find out what that experience was like for them. This may help them to look a little deeper at your side of things. They may want to try to make it a better experience for you.
Mention your increasing concern for their safety and well-being at several separate times before bringing up the idea of hiring a professional in-home caregiver.
If possible, share successful personal stories of those whoâve received in-home help.
Be prepared that this is likely one of several conversations.
Starting the conversation
Pick an optimal time to talk and begin with a partner mindset, seeking to have a genuine conversation about the concept of in-home care. Try not to enter into the conversation with an agenda of convincing them they âshouldâ.
Consider beginning with these points:
Let them know how much you worry about them, how frustrated you are that you canât always be there for them, and how much better youâd feel if you knew there was someone who could provide them with support.
Communicate your stress and the impact that has on you, your family, your work, and your health.
Describe how an in-home caregiver would assist both of you.
Assure them that you arenât abandoning them, but that you need help.
Emphasize that in-home care will enable them to remain as independent as possible, living safely in their place of choice.
Cast a vision
Choose a few ways a caregiver could support them and highlight those points. Are they tired of dusting? Do they miss the cinnamon rolls at the coffee shop just past where they are comfortable driving? Are they sick of cooking, but miss that one recipe? Would they like someone to listen to them reminisce?
Responding to reservations
Align with whatever reservations they have.
State your desire to help them as much as possible.
Take the conversation about any reservations further by asking a question such as, âTell me more. What are you concerned about specifically?â Then listen and repeat what theyâve shared so that they know theyâve been heard.
Once the older adultâs concerns are understood, you may be able to help set up a plan that mitigates their specific concerns and provides support.
Easing into in-home caregiver support
To make it more comfortable, consider having a trusted family member there for the first couple of visits.
Bringing in a caregiver as a housekeeper, driver or cook and then easing into companionship or personal care can be a âgentlerâ start.
If there are any, have them outline any areas of the home they donât want the caregiver to have access.
Start with just a handful of hours a week and increase over time as needed
Responding to a hard ânoâ
Most everyone wants to have as much autonomy as possible, for as long as possible. If the older adult responds to the idea of having in-home help with an adamant ânoâ, honor their answer and drop the topic. Consider asking if you can check in again about it at another time. Change is hard. They may warm up to the idea after thinking it over for a while.
If over time, the reply remains a hard ânoâ try to have peace of mind that youâve done what you could and that you are honoring their desires. As hard as it may be, the consequences that may come from them not having the support at home will be theirs as well. They may still have chosen those consequences over bringing in professional in-home care.
If a doctor says they are not safe without a caregiver
In a situation where the older adultâs doctor is clear that they are unsafe without a caregiver, the one legally responsible for them is required to ensure a safe environment where their needs are being met. If possible, have the doctor communicate this message clearly and directly to the older adult. In a case such as this, in order to keep them safe, the responsible party may be required to make decisions that may not always align with the older adultâs desires. Likely there are many other ways where their wishes can be honored.
You have parents and in-laws getting older: what stage are they in?
Think about the older adults in your family circle. Are they healthy and independent? Are they slowing down a bit? Or are they needing lots of help? Most families move through similar stages on their care journey. Our Care Road Map shows what may be ahead. There are specific tools you can download to support at every stage of the journey.
The Five Stages of the Eldercare Journey
Check out this road map. Where are the older adults in your family circle?
Some families are on the far left, in the âFamilyâ light yellow sectionâjust doing life together.
Others are in the âFamily Concernâ, the red section–noticing forgetfulness, a little concerned about a few falls, frailty or increased health issues.
In the light blue section, it shows how a fall or medical diagnosis can trigger the âHealth Decline Cycleâ, shown here by the wheel. Most older adults come out of the emergency room to rehab and then back to their living situation with increased care needs.
For an older adult, itâs not uncommon for the declining health cycle to lead to âSkilled Nursing or Hospiceâ, shown in the dark blue section.
On average, older adults will experience between two and five healthcare transitions in the year following a hospitalization. The average time for that cycle for an older adult is 21 months.
Download A Practical Tool For Each Stage
You have access to a few practical resources which will provide critical support at each stage. Each of these downloadable tools are linked on our Care Roadmap: Tools, so you can access them as they are relevant for your situation.
If you are in the yellow section with healthy and independent older adults, thatâs an ideal time to have essential conversations about care wishes. It can be difficult to start those conversations! so have a âTips for Talkingâ guide.Â
At the Family Concern stage, we have a âChecklist of Warning Signsâ to help identify specific areas to assess in order to determine where support is needed.
