How will you care for your parents?

The final assignment in my PPS825 (Intro Health Policy) class for Masters students this fall was to develop a plan for how the students planned to care for their parents if/when they needed help and support. The students in the class took this very seriously and did such a great job on this.

The assignment prompt is below and could be useful to help you think through some of the issues. I am in the process of trying to get a book contract for a working title “How to care for your parents without killing yourself” and used several draft chapters as course materials this fall. I am planning to crank back up some blogging focused on this topic in 2019.

End of Semester Assignment in Lieu of a Final Exam, PPS 825

Due December 7, 2018

Identify an older person (parent, grand parent, etc.) and develop a plan for how they will be cared for as they age and potentially need help and support from someone else/others to manage basic life navigation like paying bills, shopping, keeping up with medical appointments and taking prescriptions on time. Later they may need help with activities like dressing, bathing, using the toilet and eating. Also consider this person’s (it could be a couple if you wish) current housing needs as well as their future ones.  In developing this plan, consider these questions and ideas, that may not be equally relevant in all cases:

  • Age and likelihood of when s/he may need care, or what type, and for how long?
  • What are the biggest problems that you foresee in making a plan to care for this loved one? Seeing it through.
  • Be clear about help Navigating life, housing and more basic care. Think through how these are related, especially the timing of changes (earlier housing changes could reduce fall risks, for example).
  • What is the financial situation of the individual.
  • What types of insurance does the person have? Medicare, Medigap, Medicaid, Private LTC insurance.
  • What is their current housing situation.
  • How many people will be involved in caring for this person(s)? Have you communicated about this?
  • Has this loved one made clear statements of preference for these and/or related matters? In related fashion, do they have a will? Plans for where they will be buried/cremation? Have durable power of attorney of any type been considered?
  • Have these issues been discussed with your siblings/others who will view themselves as having a stake and/or a say in how this person(s) is cared for? If no, can you initiate a discussion? If there are tensions, how can you seek to address and reduce them?

Products:

  • A 500 word letter addressed to the family in question, laying out the basics of your plan for caring for this person(s), including specific questions that you think should be asked and answered to prepare for the future. Be sure to note uncertainty that you may have, but also provide your recommendation(s) about what should be done to care for or to prepare to care for a loved one.
  • Longer document of 2,500 words that lays out more details about the plan, including a timeline of important questions to answer, broken down into next 6 months, next 3 years, next 6 years, next 20 years. These time periods may not all be equally relevant for all situations.
  • 1,500 words that lays out at least 2 public policy changes, and 1 individual change that you can undertake that you think would help your children when the time comes for them to begin talking with you about a plan to take care of you.
  • Any documentation in the way of appendices to support you analysis and decisions.

LTC Model Development in China

A quick post from the plane on the way home from a week talking about LTC policy in China, and visiting a variety of LTC/elderly service delivery institutions in and around Shenyang, which is in the North East of China. I was there via a World Bank project in conjunction with the Development Research Council (DRC) which is a Chinese governmental research and analysis unit that is a part of the State Council of China that does work supporting health and social care delivery.

  • There seems to be great interest in testing and evaluating new and divergent models in LTC delivery. I found the week to be an intellectually invigorating exercise of thinking through what I know about the U.S. LTC system and trying to learn more about China’s system, and trying to figure out what that might mean for China going forward (and for China as a model for other nations).
  • A key theme of the week was the Government’s goal of increasing private delivery (as opposed to, for example, a government run nursing home) of LTC. We visited several NGOs that have repurposed existing facilities into LTC delivery/adult day care type centers. It was especially interesting to meet two young people (30s is young for me now) who had advanced degrees from the U.S. but who returned to their country to do new things in LTC.
  • There are also very interesting moves toward Government directly paying for services that are delivered by private entities, be they NGOs that would be like non profits in the U.S. context, or for profit entities. They are in the process of getting the relevant laws and regulations lined up with goals in this area.
  • One visit really stands out. We saw a very large, modern set of facilities that are like a continuing care retirement community (CCRC; independent apartments, assisted living and a nursing home facility all in one place) that the Chinese Government had built, and that a private company was running.
  • There is a great stock of empty Nursing Home beds in and around Shenyang, especially in the more rural areas, while in certain (city center) neighborhoods there are waiting lists.
  • A key demographic reality is that China is now nearly as old as the U.S. is (in terms of percent of the population age 65 and older), but it has aged far more rapidly than did the U.S. This means that LTC is a more pressing issue even as China is just beginning to move toward broad major medical insurance coverage (the 2009 reforms now have around 1.4 Billion persons covered by health insurance, though there is a huge maldistribution of care delivery infrastructure. The point is that the U.S. has gone decades since the passage of Medicare and Medicaid without directly addressing LTC. China has a chance to build an insurance system that better integrates LTC into the overall system.

I will have more to say on this, but a great trip. And on the tourist angle, if you get the chance to visit the Chinese museum that is adjacent to Tian’anmen Square, it is very well done and I highly recommend it in addition to the sights in the square itself.