Your Life Simplified

Difficult Conversations: Long-term Care for Loved Ones

August 4, 2020

Long-term care insurance is just for the elderly or chronically ill, right? While those are common recipients of care, a stroke, sudden disability or other unexpected health issues can raise the need for care to those who may not have planned for it. Asking loved ones if they’re prepared for these situations can be equally difficult. So, we’ve invited Lindsey McCool, Ed Simms and Jerry Clark, of Mariner, to join us, share their experiences and help simplify the details of what can be a very complex subject.

Additional Resources:

Understanding Your Long-term Care Options

Long-Term Care (LTC) Insurance—Is It Right For You?


George Fernandez: Thank you for downloading this episode of “Your Life Simplified.” My name is George Fernandez, and I’ll be your host. On today’s episode, we’ll be discussing one of the most important conversations you could have with your loved ones. And that is, what do you do if someone needs care, if your loved one needs care? Whether it’s a disabling event or the care we need ourselves as we age, communicating the kind of care we want to have, as well as type of care we’re prepared to provide, is really important.  

Let’s face it. None of us really expect to be a burden on our family and friends. So, that’s why it’s important that we have this conversation today. So, to help us break down this topic today, I have three guests with me. The first is Lindsey McCool. She’s a senior wealth advisor at Mariner and has extensive experience working with clients on these types of situations. My other two guests come straight from our insurance services group here at Mariner. They’re Jerry Clark, senior consultant, and Ed Simms, senior insurance consultant. Thank you, guys, for joining us today. Appreciate you being here.  

Jerry Clark: Thank you. 

Ed Simms: Good to be here. 

Lindsey McCool: Thank you. 

George: So welcome to the show. And before we begin, what I thought maybe we could do is just a quick round of introductions. Maybe if you could just share a little bit about where you come from, but included in that, if you could also share maybe just a brief reference to why this topic is important to you personally. So Lindsey, I’ll begin with you. 

Lindsey: Great! My name is Lindsey McCool. I’m a senior wealth advisor for Mariner and have been in the industry almost 15 years now helping serve clients and families. And I think the reason why this topic is so poignant for me is just because in working with my clients I’ve just seen how much this really pulls at their heartstrings, that as they see their parents aging and wanting to be able to provide the best level of care for them, but yet trying to be realistic with their level of skill and time. And just seeing how with the aging demographic of the country that this is definitely going to become more top of mind as individuals age. And so just really trying to help those individuals with all that we can offer to help them to be able to make the best choices and care for their family.  

George: Okay. Ed? 

Ed: I’m Ed Simms. I’m the director of the insurance division here at Mariner, and my role as it relates to the care planning really boils down to exploring the marketplace and when it’s appropriate to use a financial instrument to help mitigate the financial effect of giving care. It’s my role to help search out the marketplace and understand what’s available for our advisors to offer their clients, so that we can have the full breadth of options to provide in terms of the solutions. 

Jerry: I’m Jerry Clark. I’ve been in the industry now for 33 years. Stamp-on date goes to 1986. It’s kind of funny because you think academically as you work with clients and you think about taxes, you think about risk and it’s all kind of like widgets. But two months ago, my mentor, the man that means the most to me, my father, at age 86 had a stroke. And nothing could prepare me for what took place moments after that. You know, here I am, very intelligent in the space. I understand what it is I do for a living. And yet I can’t remember two seconds worth of what the doctor told me when my dad had the stroke… little things like don’t eat this, don’t take this med, take this med at this point in time, don’t drink this kind of whatever. There was just so much stuff that came at me, and the paradigm shift I had was, do I really want to be the caregiver or do I want to be the care manager?  

George: It’s a really great point in one of the things you need, that really kind of segues into what we want to talk about today, Jerry, and thank you guys for the introductions. You know, to have this discussion, there’s really four key points we should probably discuss. And number one, I think why it’s important. I think we should have a brief discussion about that, but also, we should have a discussion about what I need to know about how to receive the kind of care that I want to receive. So someone who’s going to receive care later, I think to your point, Jerry, but also what it means if you’re going to provide care for an individual, and then to your point as well, Ed, how do we mitigate the costs? You know, what are the things we need to think about when we think about the overall cost?  

You know as I began preparing for this discussion, I did a little bit of research and pulled together some stats. So consider this: the average age of death in 1950 was age 68. Today, that is age 79. I mean, just think about how much longer we’re living today. And I think that’s really indicative of the kinds of decisions that we’re going to be facing over the course of our lifetimes. There are over six million U.S. residents today that are over the age of 85. You mentioned your father, who’s 86, and my father is 91 years old, and so I know exactly what you’re talking about. You know, roughly 50% of Americans above the age of 40 believe that almost everyone is likely to require some type of care in their lifetime, while 25% think that they’ll need it for themselves. So, there is just a little bit of disconnect there between who thinks they are going to receive it versus who they think will receive it—it’s somebody else.  

And, of course, the average cost of providing for care today is about $45,000 a year, unless you’re having a private room, private kind of residence, if you will, and that could be $70,000, $80,000, $100,000, and those are just averages. Those dollars actually become much, much higher depending upon, or could become much higher, depending upon where you live. So, if someone turning 65 today has a 70% chance of needing some type of care in the future, and we know that women need care for longer periods of time, how do we prepare for that? Why is this an important discussion to have today? So, I want to expand just a little bit on a couple of stories here of just why this is important. So Lindsey, I’m going to begin with you, and I’d like you to share a specific example of the conversations that you’ve had with your clients or with your family as to why this is an important discussion to have today.  

Lindsey: Absolutely. You know, it’s never too soon to have these kinds of conversations. I think it’s such a sensitive area that everyone just wants to push it off. But, you know, it honestly comes down to maybe multiple conversations. And if you start having those conversations sooner than when the time is there with that loved one, it just makes it that much easier. We have found sometimes it’s hard. How do I break that ice with those loved ones? My husband and I have been working on our estate planning recently, and we thought, we’ll just ask my parents what kind of estate plan do they have set in place? And what kind of care do they want when that time comes? And it was just a really natural way to do it. And we even did it over a Thanksgiving holiday. So, it was just real easy conversation.  

George: Yeah, that’s a really great point. One of the things you said was having the conversation more than once. It’s not a one-and-done discussion. And I was at a conference about three or four years ago, and I listened to the speaker share her story about how she helps clients with this. She’s also a physician, and one of the things that she shared was that your long-term memory is the last thing to go. I think we all know that. Those of us who have worked with parents or taking care of parents, we know that it’s the short-term memory that usually goes first, right? If your long-term memory is the last thing to go, then if you have this conversation frequently enough, it becomes embedded in your long-term memory.  

And that was one of the most important things that I think I took away from this particular conference was because, if we have this conversation routinely, and I wouldn’t say every time we get together, of course, but at least regularly enough that it gets solidified in that long-term memory, then when the event occurs, they’ve already prepared for that mentally. And things don’t become quite as much of a surprise. It’s when we don’t expect it and when we don’t have this discussion and we don’t express our wishes where we run into those challenges.  

So, this is a really important discussion to have, I think going forward. Jerry, you mentioned your father’s situation. Can you maybe help us understand maybe a little bit… we’ll get into more of the caregiver-care recipient topic a little bit later, but is this a topic that you all discussed regularly beforehand?  

Jerry: Yeah, so there’s four children. I’m the baby of four. Mom had four kids in five years. We’re pretty close as a family, yet we’re very different. We’ve all been raised pretty independent. My dad, he’s the Greatest Generation ever, millionaire next door-type, wanted to self-insure and all that because “I got plenty of money.” By the way, my mom predeceased 15 years ago. So we get the call from a friend of my dad’s that something’s wrong. He was refusing to let me call an ambulance. Everything evolves real quickly. We get to the hospital. The conversations that take place after that are just very strange, because all kids process information differently. And so, where we’re at right now is dad has had a full recovery, he’s actually, I think, doing better post-stroke than the month leading up. So something was going on.  

But we’ve dodged a bullet here. We’re able to sit down and have a conversation with my father and talked to him about, okay, this is what we need to be doing right now. You did choose to self-insure. What are your plans? Who do you want to take care of you? Do you want to live at the farm forever, as long as you can? Do you want to move into town? Do you want to live with one of us? And it’s little things like it’s painfully clear that I don’t want you guys living out here, so I want a nurse.  

But now what we’re faced with is my dad is tighter than 13 layers of paint, going back to the fact that he’s the millionaire next door, the Greatest Generation ever. He came up from the Depression. So now dad’s saying to us, “I want care brought in. I don’t want you caring for me, but by golly, I don’t want to spend my money right now. So, since everything’s okay, you can come out and mow the grass and you can do this and this and this.” And so, I’m explaining to Ed all the time, “Hey, I have to run out to the farm to mow my dad’s grass and do this and that.” So it’s kind of an interesting situation.  

George: You mentioned something right at the front end of that, which was, you dodged a bullet. This was not a typical conversation that you’ve had along the way, but because of the circumstances and the recovery, it offered you a second opportunity to have these conversations going forward. And now you’re having the conversations, as easy or difficult as that can be. You’re at least able to have those conversations.  

I worked with a particular client several years ago, probably 10 or 15 years ago, and when we started having this conversation, the husband completely cut off the conversation and just refused and would not allow the conversation to be had in his house. Unfortunately, a year later, when he retired, two days after he retired, he had a massive stroke, and he didn’t recover from his stroke. He was paralyzed on one side, and it just turned from bad to worse after that. And because there was no opportunity to have that discussion beforehand, because he refused to, there was no opportunity to even discuss it with the wife because it happened so quickly after we had the conversation. It’s so important to have this discussion, because if you encounter an individual who doesn’t want to have the conversation, many cases they’re married, so you need to have the conversation with the other person.  

So this is a great segue into our next point, and that is expressing your wishes as to the kind of care that you want to receive. We were saying a little bit earlier that only 25% of us think that we’re going to need care for ourselves. However, we think 40% of everybody else is going to. We said that there’s a little bit of a disconnect going on there. Regardless of whether you think you’re going to need care or whether you do normally need care, I think the important thing is that you should be expressing how you want to be cared for.  

So that’s what I want to talk about now is how do you express your wishes to your family members as to the kind of care that you need to have? And so I’d like to talk through maybe some kinds of questions that we should be thinking of or issues that we should be thinking of as we think about our own care. Let me kind of start with you, Lindsey. When you think about having that conversation with a parent or loved one about the kind of care you want to receive, what are the top-of-mind things that come to you?  

Lindsey: The things that come top of mind to me is looking at making sure the appropriate documents are in place from an estate planning standpoint. And so thinking about health care, an individual should have a health care directive. Some people call it a living will, but it’s essentially a document that outlines how they want different situations handled in that end-of-life stage. And then also having a health care power of attorney and having individuals named in that health care power of attorney that you feel comfortable and competent in that would make good health care decisions for you when that time comes.  

In my experience, I’ve come across a situation where a client of mine, at that end-of-life phase, and was at a religious-based hospital, and they were not able to carry out this individual’s health care directive. And so it became necessary for the family to move the individual to another hospital so that they could receive the care that they wanted to have for that individual. And so I think those things to me are what’s top of mind—is making sure the appropriate documents are in place and that you’re mindful that maybe not every hospital is able to carry out your wishes as you would like, but be mindful that maybe you might need to find a hospital that would. 

George: You raised a really important point. And as you have these conversations and you document these conversations with your family members, you should also be taking those back to the doctor, because it’s important to understand whether or not your wishes can be fulfilled the way that you’ve described them. And I think that’s a really great point. And I don’t know, it’s one that probably comes up very often, but it certainly can. Jerry, you had something you want to add to that?  

Jerry: Lindsey, you made a really good point. I was just going say with the four children in my dad’s situation, we’re now injecting humor as a family, whereas two months ago, it was very touch and go. But right now, we sat down as four children, and we all looked at each other and we’re like, “Who’s going to be the health care power of attorney?” And we all pointed to my oldest sister because we’re too emotionally involved. And if we can’t do what dad wants us to do, but Diane, on the other hand, the oldest sister, she’s like, “I won’t like it, but I can do it.”  

George: Yeah, that’s a really great point. My wife cared for her mother, and her mother actually lived with us for 11 years. And she was her caregiver as well as her medical power of attorney. She’s the rock in the family, so she is able to make those hard decisions when they have to be made according to the wishes that her mother had. And so I think that’s a really important point. 

Ed: So one of the things I wanted to touch on is when I’m involved in new conversations with advisors and clients, I like to talk about the planning continuum in terms of the spectrum, in terms of the type of planning we can do. Is there a goal to be at home for the rest of their life and stay at home and have care be given by whoever they want to have care from? Do they want to be dictated by an insurance company as far as who provides that care or do they want to plan for Medicaid? There’s the whole spectrum. Not many people want to do that, but depending on the family’s facts and circumstances, that sometimes is the only option. So it’s the whole spectrum. It’s important to make sure that everybody’s aware of all these different options.  

And one other thing I might mention is that I help a lot of advisors and their clients at the time of claim help understand the claim process and actually help process claims. And one of my experiences was recently, I was on a conference call with five siblings, and none of them could make a decision on exactly how they wanted the care provided. And the mother had a plan with unlimited benefits of long-term care. And they hadn’t filed a claim in a year, and it was getting pretty messy. So there needs to be a point person for all these plans. Once they’re put in place, we’ve got to have a plan to move forward and be able to manage these claims and so forth going forward. Because we spent an hour on the phone discussing all the different options. So that’s a sensitivity as well. But in terms of plans that can provide for home care versus non-home care and so forth, there’s a lot of different options.  

George: I think that gets back to an interesting point and that is when we look at this kind of situation, I think it’s important we realize that we don’t have to be alone in any of this. We have professionals like you, and like you just described in the conversation you were having this family. Lindsey, you shared that as well. And of course, Jerry, you were sharing about how your family came together in this and collectively with cool heads had a conversation about how to move forward with this.  

And I think that’s really important as we have these conversations with our loved ones about the kind of care they want to receive, that we don’t have to be alone and that we can have others come alongside us to have these conversations. If you’re an only child, then work with a wealth advisor, as an example, to help have that conversation. If you have siblings, then have a meeting beforehand together before you talk with mom or dad, so that you all come together and have cool heads about it, because it can be very highly emotionally charged engagement. So, really important that I think we keep those things in mind.  

George: So one of the things that we’ve actually created here at Mariner is actually a list of questions that you should be asking or thinking about as you go through this thought process of the kind of care you want to have and how to express your wishes. So, at the end of the podcast, we’ll give you instructions on how to get and gain access to that information. So, segueing into the caregiving perspective. As I mentioned a little bit earlier, my wife and I cared for her mother for 11 years. What you might not realize is that nearly 10 million people over the age of 50 are caring for an aging parent, and about 43 million caregivers have provided unpaid care to adult or child in the last 12 months. These are significant, very large numbers. So, I think the fact that it’s going to hit one of us listening today is as a very high probability.  

It’s also important to know that a majority of caregivers care for one adult, while 15% of folks who provide care actually are caring for two adults. So sometimes it’s not necessarily mom and dad, maybe it’s mom and mother-in-law and maybe it’s the same house and a different house. So, I think it’s really important to understand the impact that this has from a caregiver perspective. When we think of being a caregiver, though, a caregiver’s responsibilities have to transcend that emotional piece that Jerry, you were talking about a little bit earlier in your description with your family. You decided that your sister would be the power of attorney because she was best emotionally suited for that, and that’s a really important thing to kind of keep in mind.  

I think some of the things we have to think about when we think about taking care of a family member is you have to begin asking yourself questions as to what you’re going to be comfortable with. And so, what are the things that come to your mind as far as what do you think you have to be comfortable with when you start caring for someone else?  

Jerry: I have several. Unfortunately, I have two long-term care situations going on. My father-in-law’s terminal with cancer and then my father with a stroke. Take my father-in-law, for example. He’s frail, he’s lost a lot of weight, obviously. He’s in his 80s. One day he can’t get out of a chair, I mean, literally cannot even stand up to go to the bathroom. So, my mother-in-law calls my brother-in-law, he comes over. Brother-in-law’s a big guy, big sports guy. He throws out his back taking him to the bathroom, literally falls on the ground, wrenches his back real bad. You’re just not prepared for it. And you’re kidding yourself, if you haven’t gone through training, you’re actually kidding yourself that you’re going to be a caregiver. It’s somewhat of a joke. 

George: You think through those typical things. There’s a really great question out there that you should be asking from a person who needs care, who’s going change your light bulb? If you can’t stand on a chair and you can’t climb on a ladder, who’s going to change your light bulb? So, who’s going to be helping you with that? So that’s one of those household chores that we will be called upon doing when we are being a caregiver is going to be changing light bulbs. It’s going to be shopping. It’s going to be preparing meals. It’s going to be going to doctor’s visits. It’s going to be going to social outings. It’ll include any kind of errand you can imagine that you’re going to need to be running with this individual.  

You raise a really great point, Jerry, and that is you will be lifting them in and out of beds, out of chairs. And there are special techniques you use and tools you use in order to do that. In my case, I was very fortunate that my wife actually worked for three years in a nursing home when she was growing up. She was actually a nursing student. And so that prepared us a lot, but it didn’t necessarily prepare us for the next thing, which was getting her dressed every morning, toileting her, bathing her and the most important piece, which is being on call 24/7. Those are the things that when we think about taking care of our family members, we don’t often realize—that’s the extensiveness of it. And so that’s why it’s important that we’re not alone. So Lindsey, you have something you want to share on that?  

Lindsey: First, I’d like to say is you don’t have to do it all yourself. I think when you’re caring for somebody, it’s important to have a team around you. Maybe that is a skilled professional to help during the day and maybe another skilled professional at nighttime, or whatever fits your schedule and whatever fits with your family. But you don’t have to do it alone. There’s lots of professionals out there to help, whether it’s skilled care or someone that needs maybe more of a therapist-type help or whatever it might be. There’s definitely lots of professionals out there.  

George: Absolutely. Again, being a caregiver, there’s a lot of activity that goes along with that, and we don’t have to do it alone. And other questions to consider is am I the best person? I think, Jerry, you raised that a little bit earlier. Am I best person to take care of them physically, as well as take care of them from the financial perspective and so forth? We have some great tools to help with that as well. And so finally, the last topic I want to talk about is really mitigating the costs. I mentioned a little bit earlier that the cost associated with caring for loved ones in the home can be very, very, very expensive. Facility care is very high, as well as caring for in the home. And so self-insuring is certainly an option that I think you were describing that a little bit earlier, Jerry. But what are some of the other options out there as it relates to mitigating the costs? Ed, do you want to share a little bit about that?  

Ed: Sure. So, when we discuss mitigation options for providing care for these situations, we really look at about three different options. One is a traditional long-term care insurance strategy. The second option is a hybrid strategy, which provides a guaranteed cost recovery mechanism. And the third option is a life insurance-based strategy that provides for an advancement of the death proceeds for long-term care.  

The benefits of the traditional long-term care policies are the fact that their costs are low in the early years, but their rates aren’t guaranteed. So, it’s very common for our department to get a phone call from an advisor that says that their client has received a notification from the long-term care carrier that they’re increasing the rates. And this is a very common call that comes in, and that’s the downside of a traditional long-term care policy is the fact that the rates aren’t guaranteed and not a lot of people are excited about paying more premiums for the rest of their life. Commonly, the traditional long-term care policies are referred to as a reimbursement strategy. There’s two types of benefits that can be received for long-term care benefits. Number one, a reimbursement, which means you have to be on a certified plan of care and that care needs to be provided by a certified caregiver, and then the expenses related to that care can be reimbursed.  

The other type of strategy is referred to as an indemnity strategy or think of it as a cash benefit plan. And these indemnity plans or cash benefit plans are exactly that. So, once you trigger the benefit of two of the six activities of daily living or a cognitive impairment, you will trigger the cash benefit that will be paid monthly for whatever the duration of the contract is. So, for those people that want to stay home and choose the people that care for them, a family member or so forth, the cash benefits are a much simpler and easier way to mitigate those costs. And it’s a lot less hassle.  

So, the traditional long-term care is a reimbursement strategy. The hybrid strategies that provide for the guaranteed cost recovery mechanism are both; you can access them either on a reimbursement basis or an indemnity basis. So, it makes a lot of sense to explore all your options and all three of those aspects.  

George: As I listen to you describe each one of those pieces, I’ve been doing this a long time, working with clients for a long time and have gone through the training necessary to understand all the words you just used, Ed, but I can just imagine how overwhelming that must feel listening and hearing the complexities that are available. And I think it’s important, probably, I don’t think we can go without saying that get help when you’re making these kinds of decisions and looking at the mitigation of these costs, because there are a lot of options that are out there, and they can be very complicated and some work better than others, depending upon your situation.  

It’s important to also know that Medicare doesn’t cover these expenses. They might cover a little bit on the front end when you, for example, Jerry, in your father’s case, he had his stroke, he went into rehab probably soon after that. And there was an element of Medicare that covered a part of that. But once you hit that plateau and no longer progressing, then you’re turned off and then you’re on your own after that. And so you need to have a way to cover those costs.  

There’s also coverage or cost mitigation at the very end of life. So, when you go through and you have a condition that is terminal, as an example, hospice will come in and provide a tremendous amount of care, resources and cost recovery. But it’s that gap in between that we don’t often think about of how we’re going to cover that. And so that’s really important to consider. The other piece of that, too, is how do we pay for the things that those things are not necessarily covering, which are the extensive travel that you’re going to have to make if you’re not living close by and you have to fly in to take care of a parent or a loved one. There’s a lot of other ancillary expenses that can come into play when you’re caring for a loved one that you may not be prepared for, that aren’t typically covered in these kinds of policies. So, you need to look at ways that you can, whether it’s self-insured or set dollars aside for that. I think another great point.  

So just some final thoughts from us as a group before we conclude the podcast today. What are some other ideas and some other things that we should be considering or we should be talking about?  

Lindsey: One thing to add to where we are in the conversation is I have a client that I was working with recently. She had finally gotten to the point where she had been helping care for her parents in their home. And now it’s gotten to the point where their health is no longer good enough to stay in the home. They had to start looking at skilled facilities. We helped them evaluate the skilled facilities here in Tulsa, and then also helped look from a cash flow perspective because they were on a very fixed budget with Social Security and some distributions from their retirement accounts. It was going to go from $4,000 to $8,000 a month. And they weren’t sure if they could afford those skilled facilities and which skilled facilities could they afford. We did an analysis to show that, even though those monthly expenses are going to double, they can still afford it. And so they should still choose the skilled facility of their choice, not just take the lowest cost provider.  

The only other thing I thought of was that the caregiver, just the importance of the team, because it can be so taxing on that caregiver, I can’t tell you. I have a couple clients right now that are doing so much care for their parents that when they come in, they’re relieved to sit down with me because it’s like they have a break for a little bit. So just going to be talking to them, making sure you take care of yourself and still make your health and yourself a priority, even though you’re caring for those aging loved ones.  

Jerry: Lindsey, this is Jerry. On that front, the statistics are overwhelming. The physical toll that it takes on a caregiver, and the emotional toll it takes on them, is unimaginable. I can tell you that, for example, the night of the stroke, I was the one that stayed at the hospital with my dad that night. I physically had to fight my dad twice in the night. And I can’t tell you what that did. It was so weird. It was so hard to process. Once again, we dodged a bullet, and we got our dad back. But imagine that is now the reality going forward, and I am the caregiver, and I’m physically fighting my dad. That’s not good. 

Lindsey: Yeah.  

George: No, those are really great, great points. It’s real interesting that you say that, Jerry, because when my wife and I were taking care of her mother that last year, just before she passed, we had hospice come in. And for the previous 10 and a half years that she was with us, my wife and I were the ones that were her primary caregivers. And you’re right—I mean, there were times it was very emotionally taxing. It was emotionally draining and physically draining. That last six months, or I should say the last two months, before hospice came in, my wife was literally up 18 hours a day and managing her care because she got to a point where she couldn’t get in and out of bed by herself, so she was a fall risk.  

We had to call the fire department, 911, twice when her mother fell. One time she got wedged between the wall and the toilet, and so we had to call fire department. Now we kind of joke about it a little bit because when the fire department shows up, her mother was very excited about all the young firemen that were there. And she says, “Oh, I’ve never had so many nice young-looking men in my room.” And so, it was really funny. The second time that it happened, we almost wonder if maybe she was trying to repeat that. We don’t really know for sure, of course, but it was really interesting that we didn’t realize that emotional and that physical toll it was going to take. That was probably our biggest surprise. And I felt like that we were probably better prepared than most. 

But there’s another piece of this that I think is important that I don’t want to lose sight of. We’ve talked about the downside a lot today, but there also is an upside. And when you are a caregiver, believe it or not, one of the things that I can share personally about the caregiving experience that we had was while yes, it was difficult, and while yes, we encountered things that we never expected, and it was physically and emotionally draining and daunting, there was an aspect of unbelievable reward in that relationship that we had with her during those years, because we had had those conversations ahead of time.  

We knew what we were planning. We had a plan of action going into it. Yes, there are things that we didn’t expect, but that preparation took the burden off a lot of that pressure because we weren’t surprised by everything. And that allowed us to enjoy some fantastic years with her mother and our household, with our kids during that period of time. We have story after story after story that will just send the audiences laughing on the floor, as well as heartwarming activities that took place. Do you have any final thoughts on that?  

Ed: Yeah. I just want to make one final comment regarding people that are exploring the mitigation techniques in long-term care. And this is not something that the insurance companies want to let anybody know, but if you are on the fence as far as doing long-term care or not, one of the things that you can do is you can do a genetic test and you can check your ApoE status, which is A-P-O-E, and if you have a four as part of the… everybody has either a two, three or four, and it’s a combination of two, you get one from each of your parents, but if you have a four in one of those in your ApoE status, the chances of you coming down with Alzheimer’s is increased significantly. So, if you’re on the fence and you want to do some genetic testing, that’s one area that you can do to help you decide if that’s necessary.  

George: Does that go into the Medical Information Bureau when you do that?  

Ed: If you do it through your doctor, yes. If you do it through a private genetic testing service through like 23andMe, then no, it won’t.  

George: So, I’ve heard that when we do that that there’s a chance that that could show up in the Medical Information Bureau. So how does that work?  

Ed: So, if you do it through your doctor’s office when you go through the process of underwriting long-term care, it’s very common for the underwriters and insurance company to request the doctor’s records. So, once they get the doctor’s records, they can see that. As of today, the laws are that they cannot make a decision based on genetic testing, but the insurance companies are in the process of getting that changed. So, act on that soon if you want to. 

George: Okay. So if you do it on your own, without going through the doctor, then… 

Ed: … the insurance companies won’t ever know.  

George: Okay, that’s great to know.  

Thanks again for joining us today. This has really been a great opportunity for us to share some ideas about managing the care of our loved ones. As I said before, we have two resources available for you. One is to help you have those conversations with your family members who want to express their wishes about receiving care. The second is a document that will help you determine whether or not you’re prepared to be a caregiver. If you have any additional ideas or suggestions for podcasts in the future, be sure to let us know at [email protected]. Thanks again! 

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