As we grow older and as our loved ones grow older we are finding ourselves dealing more and more with the question of whether someone needs some sort of assistance in their daily living and what type of assistance do they need.  This is a much more basic and difficult question than how to pay for what is needed.  After having spent a lifetime responsible for yourself and in control of our own life and its daily activities, it is very difficult and emotionally trying to have to face the need for assistance in our daily living.

This issue does not first appear on the scene as you are faced with a debilitating illness or injury.  It comes on slowly and often unnoticed as it becomes more difficult to engage in many of the unconscious activities of life like dialing a phone or hearing the person on the other end of the line.  “Speak up there must be something wrong with the connection.”  The two things that we all need to be aware of is that 1) the need sneaks up on us almost unnoticed and 2) it is emotionally difficult to admit to ourselves – let alone our children – that perhaps we need some assistance.  But the failure to do so can put a great burden on your loved ones.  Putting it off often compounds the need and the cost of addressing the need.

The primary message of this essay is: Think about it now and Talk about it now.  Discuss it with your spouse and your children.  Seek counsel.  Decide what you would like your living circumstance to be before the need arises.  Revisit your decision from time to time but hold yourselves to it – for your benefit and the benefit of your children and loved ones.

Let’s deal with the issue of being aware of your need for assistance.  Why does it sneak up on us?  The stairs don’t get real steep all at once.  People don’t start talking softer all at once.  Your appetite doesn’t disappear all at once.  The laundry doesn’t pile up all at once.  The house doesn’t get dirty all at once.  You don’t forget your medications or mix them up all at once.  No, all of these things begin to happen sporadically and increase in dimension gradually.  Being aware of what to be on the look out for could help you to notice the changes sooner.  Being aware of what elements of your daily living are most important or critical to your enjoyment of life could help you notice their deterioration sooner.  We, and the world around us, seem to be aware of most basic of the activities of daily living.  Things such as toileting, bathing and dressing are easy to notice when they become problems.  But our need for assistance can develop long before these sorts of activities are beginning to become problems for us.  The first level of need arises with diminishment of something called Instrumental Activities of Daily Living.

INSTRUMENTAL ACTIVITIES OF DAILY LIVING: The first level of care is usually needed when one or more of these activities become difficult or impaired.  This is especially true if you are a widow or widower or single or if it applies to the both spouses at once.

1. Using the Telephone.
2. Managing Medications.
3. Moving about Outside.
4. Shopping for Essentials.
5. Preparing Meals.
6. Doing Laundry.
7. Doing Light Housekeeping.

And we could add using a computer, cell phone and navigating the internet.

The diminished ability to perform one or more of these activities would be the first indication of the need for taking the initial step toward some change in your housing services or your living arrangements.  Diminishment of the ability to perform one or more these activities can be preceded by the diminishment of the desire to do them.  Living alone can create that diminished desire long before the capacity to perform these activities is diminished.  Moving into a group environment or a close community can help restore that desire and motivation.

At some point living alone in your family home or the home you moved into when you first retired can become lonely and increasing devoid of the normal motivations of life.  Talk about this now long before it is likely to occur.  Determine how you are going to make the determination that the motivation or capacity to live your daily lives has diminished and you need to seek alternative living circumstances.  Discuss what those alternative living circumstances might be.  Let others know of your thinking.  Encourage them to feed back to you when they think you are approaching this stage in your life.  Go on record.

The next step is not just a more motivational and stimulating living arrangement but it is the need for assistance and for periodic intervention by trained staff.  This could be staff to clean and cook or to be even more involved in your personal care.  This is where the so-called Activities of Daily Living come into play.  Once you see the need for some level of assistance in these areas then you should again think about increasing the support you receive within your living arrangement.  Fortunately the decisions you implement to responded to the diminished interest or capacity to respond to the Instrumental Activities of Daily Living can place you in a community or group situation that readily allows you to move on to a greater level of assistance. 

Again, discuss with your spouse and loved ones how you are going to make the determination that you need this increased level of assistance and what your response should be.  Let others know of your thinking and encourage them to feed back to you when they think you are approaching this stage in your life.  Go on record.

ACTIVITIES OF DAILY LIVING: The next level of care is usually needed when two or more of these activities become difficult or impaired.  This is especially true if you are a widow or widower or single but it is true even if it is happening to just one of you.

1. Bathing.
2. Dressing.
3. Toileting and Personal Hygiene.
4. Continence.
5. Ambulating (impaired mobility requiring appliances, crutch, cane or walker).
6. Transferring (to and from chair, bend, car, commode, etc.).
7. Eating (inability to prepare food and/or feed yourself).

The above activities of daily living are of increasing importance starting from the top of the list.  Importance also increases as these activities go from scheduled to “On Demand”.

COGNITIVE IMPAIRMENT: If and when this occurs one has reached the highest level for the need for care.  If this occurs in conjunction with any of the above, as it usually does, you will need substantial oversight and care.  The burden of the second level of care, especially if it occurs in conjunction with cognitive impairment, is such that a family caregiver (usually a wife or husband) is incapable of living up to and surviving the burden it creates.  It is not usual for the cognitively impaired to outlive the family caregiver due to the stress it places on the caregiver.  It is imperative that professional, and sometimes full-time, caregivers be hired, usually on around the clock basis, or that the one needing care be placed in a facility set up to provide this care.

THE BOTTOM LINE: Don’t place your children or loved ones in the position of making these decisions for you.  Make them yourself ahead of the need and stick to your decision.  Make your decision known to others.  Go on record.

Over the years I have strongly encouraged each of my clients to get their estate plan in place and keep it up to date and in accordance with their wishes so that everyone is aware of what your estate planning wishes are – before death arrives.  The purpose of this essay is to emphasize the same need to plan for the evolving nature of your living needs, as you grow older.  Unfortunately there is not the same infrastructure in place in our society today to help you do this planning and carry it out.  Life care planning doesn’t yet have the equivalent of estate planning attorneys and trust companies.  However that may be changing more and more financial planners are making this apart of their advisory services.  Ask your planner if they are in a position to guide you in this effort.  In the Additional Resources tab section of this website you will find a contact for financial planners who emphasize Life Planning as part of their practice.  Many of these planners make this part of their life planning services.