Oscarlyn Elder:
Nobody knows for sure what the future holds. One of the biggest unknowns we all face is how long are we going to live? The other big unknown is how will our health change as we get older? Because we don't know, we have to plan ahead. That's what we're talking about today. I'm Oscarlyn Elder, Co-Chief Investment Officer for Truist Wealth. And this is I've Been Meaning To Do That, a podcast from Truist Wealth, a purpose-driven financial services organization. We appreciate you listening.
Today we're going to talk about planning for longevity, and in particular, the emotional aspects of crafting a plan for our health as we age. Our goal with this planning is to make sure the latter years of our lives will be as comfortable as possible and as free of family conflict and stress as possible. I'm happy to be joined by experts in the kinds of questions so many of us have. They are both my colleagues at Truist Wealth. I have with me Jacqueline Parks, who is regional director of Advice and Planning, and also Tony Bryan, wealth strategist. Thank you both for being here and welcome back to I've Been Meaning to Do That.
Tony Bryan:
Thank you. It's great to be back.
Jacqueline Parks:
I'm excited. Thanks, Oscarlyn.
Oscarlyn Elder:
There's a lot to this topic of longevity planning. We've talked in the past about portfolio strategies for building income. We'll talk in the future about some of the legal and financial planning elements people should be engaged in to prepare for their future healthcare needs. Today, let's focus on the why and the how of that planning, because for a lot of people getting started is the hardest part. Would you agree with that?
Jacqueline Parks:
I would agree with that Oscarlyn. I do think when we're talking about our own healthcare and thinking about a time that we're not as healthy as we want to be, it's a very difficult thing to think about and it's easier to just delay or put that planning off until another day.
Tony Bryan:
I would just kind of piggyback on that. I wanted to say it's definitely one of the harder parts of the whole process. Maybe not the hardest in my opinion, but definitely difficult and really my hope for people that have not done any planning in this area yet, my hope is that they become so uncomfortable that they take action.
Jacqueline Parks:
Yeah.
Oscarlyn Elder:
And look, it is uncomfortable to think about what might happen as I age and where could my health break down. And I think that sense of potentially losing autonomy, which really defines adulthood in so many ways, that just considering the sense of loss of autonomy is often very off-putting to folks and we just often shut down and don't want to think about it. We recognize that it's hard, but it's even harder if you don't think about it and you don't plan for it. So, there are a lot of terms when we start thinking about longevity planning. We might hear about long-term care or extended care. How do you define those terms?
Tony Bryan:
I'll say that long-term care planning, it includes a list of services for individuals with chronic conditions or disabilities. They need help with the activities of daily living, such as eating, bathing, dressing, going to the bathroom, transferring from bed to chair, and also those that have some cognitive decline. So that's what I think about when I hear long-term care planning.
Oscarlyn Elder:
And Tony, it sounded like as you were going through that, it sounded like a standardized list in many ways.
Tony Bryan:
It is a standardized list, yes, but it's important to note that Medicare is not going to cover this. I mean, technically it will cover a little bit, but for the most part, Medicare is not going to cover any of this, and that is what is so surprising to so many people I still find that today.
Oscarlyn Elder:
Yeah. Jacqueline, how do you think about these terms? How do you think about long-term care versus extended care?
Jacqueline Parks:
So, I think my perspective is probably more similar to the listeners that are with us today. I tend to use the terms interchangeably. To me when you start talking about long-term care, longevity, extended care, I think about what my life and my health will be many, many, many years into the future. I had grandparents that lived into their nineties and had varying degrees of health and needs up until the end. But it's much more than just medical care, right? It's family interaction, it's transportation, it's engagement with the community. So, when I think about creating a plan for the long term, I want to have a very full and healthy lifestyle, including medically, but with all of these other elements that we think of in being an active member of society.
Oscarlyn Elder:
So, you think of it in a broader sense, and I'll say that one of the elements that I have heard at times people distinguish is kind of like where does the care take place? Is it in the home? Is it in a specialized facility? As we've worked with clients, my observation is that folks have different perspectives on this. I've heard both voiced and I think what we try to encourage them to think about is how will they keep those engagements that are so important to them? How will they enable those interactions that really give them joy and purpose? Ultimately so much of what we talk about here ties back to values and purpose. And so really having a clear vision of what your personal values and purpose are, what's important to you so that you can be in a position to communicate that. And planning for and or really managing, in the moment, long-term care or extended care for ourselves or for a loved one can get really complicated quickly. Are there people who really should be putting a special emphasis on this kind of planning?
Jacqueline Parks:
Many of us have an assumption around what we want or what we think will happen. I think about my own parents who were able to care for their parents in their final years, and so my parents I think have that assumption that myself and my siblings would be the ones to step in and care for them. Assuming that your spouse or your children will be a part of that care plan is a pretty natural thing, but there are many of us who maybe are divorced or never married or don't have children. So, if you're a single individual or you don't have a very extensive family network, then it is particularly important that you think about these issues and plan ahead for who would step in to manage things for you if you couldn't do it for yourself.
Oscarlyn Elder:
Absolutely.
Tony Bryan:
I was thinking of some clients that I worked with where it was a total nightmare. These were blended families and had so much complexity, financial complexity that this planning was really, really challenging. So those types of families, I think, there is a larger emphasis on getting this done as well.
Jacqueline Parks:
We should also not forget individuals who have either a family history or a known risk for a particular type of illness or neurodegenerative disorders, autoimmune disease, certain cancers that make it more likely that they will suffer a period of incapacity. And so your particular health history, your family health history may also make it more important that you pay special attention and get these ducks in a row, if you will.
Oscarlyn Elder:
Absolutely. That is really great insight from the both of you. For me, when I think about my future, I have an only child who's absolutely wonderful, but it definitely impacts how I think about needing to prepare for the future for a number of reasons because I don't want her overburdened. I don't want her to have to sacrifice her life and her goals to care for me. Then I recognize I could also be in a situation where she's living across the country and I just don't have a direct support structure, so I've got to think through that and you kind of called that out.
To sum up, planning for long-term or extended care is complicated, but it's so important and there are strategies that we can use to give ourselves the best possible odds that those challenges won't be a burden for us or our loved ones as we age. When we come back, let's talk about ways that we can approach this process with care.
Tony and Jacqueline, we talk a lot about planning on this podcast. Usually planning earlier is better than planning at the last minute. Often, we have a natural and completely understandable tendency to put off difficult and emotional and uncomfortable conversations. Talking about how our health may change as we age is definitely uncomfortable and emotional, so am I right in thinking that delaying the conversation might just make it harder?
Jacqueline Parks:
While it's understandable that people would avoid conversations about aging or incapacity or long-term care because they're emotional and uncomfortable, delaying the discussions does make things significantly harder. A sudden health crisis like a stroke or a serious fall could happen without warning and it could leave a person without capacity to make decisions. At that point, the legal and financial options available will be limited and the family is then left to make very urgent choices without really having guidance from you.
Tony Bryan:
I've seen it with clients so many times and I've seen family relationships just totally get destroyed, and it just didn't have to be that way. It really didn't.
Oscarlyn Elder:
The way that I describe it is that it's possible that your world goes from this really wide view where you're able to consider lots of different paths and you've got kind of this space and the energy to have the conversations, but in that moment, when that health thing happens to you, your world becomes very focused, very limited on the moment. So that's why we're having this conversation today is because we really want to encourage people to have the conversations earlier. It might be the older generation who starts this conversation about their own future care plans and desires, but it might also have to start from a younger generation or even potentially a sibling. Adult children often worry about their parents very intensely either because they don't know if the parent has a longevity plan in place or they know that they do not, and we see really all of those types of situations. What's a good way to start the conversation on this topic that actually might lead to somewhere positive?
Tony Bryan:
I actually have a really good way because I've done so many things wrong. One thing that's worked is when you ask a family member to give their thoughts on if something happened, like say Uncle Billy and Aunt Mary, they went into an assisted living facility. So, ask them, "What do you think about that? What are your thoughts on that?" Or they went into a nursing home, what do you think about that? And then they'll talk about it and then you can start the conversation that way as opposed to trying to force them to talk about their own potential health decline because I've tried to do that too. That doesn't work. That doesn't work at all.
Oscarlyn Elder:
Jacqueline, how do you think about this?
Jacqueline Parks:
So, I think it's best to approach the conversation with respect, with empathy and focus on the parents' wishes and their independence. You could say something like, "Mom or dad, I know these conversations aren't easy, but I've been thinking about how important it is to understand your wishes. If something were to happen unexpectedly, I want to be sure that we're prepared not just legally and financially, but as a family, so we could support you in the way that you want." And just ask them, "Can we find a time to talk about what matters most to you and how you would like things handled if your health ever changed?" So, you're not saying, "Oh, I see something happening or I'm worried about your health now." You're just saying what if... and allowing them to explain how they would like to best be cared for.
Oscarlyn Elder:
Jacqueline, what you bring up there is that the framing of the communication, the framing of the interaction and the questions matters greatly. Given your values, what's really important to you and what do you really want to preserve? For some folks it might be the social interactions which might influence the path forward. For other folks, it might be their connection to a neighborhood. It can run the gamut. The important element is to present the frame that's positive, that's not threatening, that gives folks the experience or the opportunity to engage. That said, it's also really important that folks understand that there's the potential that there will be a desire not to talk about this, and we've got to respect that as well and perhaps come up with a strategy to bring the subject up multiple times but in respectful ways. And it could take that to make progress.
Part of that making a plan involves assigning roles. So, who's going to have the power of attorney? Who might be empowered to make medical decisions? Who may be the trustee and so on? What advice do you have for navigating thinking about who may play which role in your life as you need either long-term care or extended care?
Jacqueline Parks:
So, I've worked with a lot of families in making these decisions over the course of my career, and what I've seen is that a lot of families do tend to default to naming their children either in birth order or naming all of their children jointly together as a way to avoid hurting feelings or avoid making a decision. I don't recommend that, and birth order isn't necessarily the right order either. For the person you want to select to manage your finances, typically, people will select a child who tends to be business-minded. If they have a child who's an attorney or an accountant already, that tends to be their first choice. That can be a great choice, but also remember that this person maybe has a very high demanding career and they may not have the time to take on the role, so it's something to think about.
When it comes to healthcare decisions, then people will tend to choose... Again, if they have a child who's a doctor or a nurse or in the medical profession, they will choose that person first, but it doesn't necessarily need to be that person. I think I would just discourage people from naming children jointly because that can lead to conflict. Certainly people have different opinions, and in a moment, you need to have someone who can make a decision and answer the doctor or make a decision about an account. So having multiple decision holders in succession of control is a good thing, but not serving together typically.
Oscarlyn Elder:
I have a memory of a client situation where the medical power was co and there was some difficulty finding the co and there was an urgent decision that needed to be made. And frankly, everyone was scrambling trying to understand what do we do next if we can't find the co, how do we get the co engaged? And it really created about 12 hours of panic. I've seen documents not on the medical side, but on the financial side where three people might have to all agree or maybe two of three agree. I mean, I know you've seen some of that complexity, and the reality is even though these folks may all come from the same family, they have different experiences, they have different perspectives. They may have similar values, but the expression of the values may be very different or the values may be very different. And so, when you start adding that complexity in an intense moment in time, it can just create really negative unintended consequences. So, our advice is, if at all possible, enable one person to make a decision, especially in times of high distress,
Jacqueline Parks:
Agreed, but also have a list of successors just in case that person isn't available for whatever reason.
Oscarlyn Elder:
That's right. Have the list of who comes next, but try to simplify the process as much as possible in that moment of intensity or distress. That's very good advice. Tony, what would you add?
Tony Bryan:
I was going to add about the financial power of attorney. You need to have someone who is both trustworthy and competent. They have to be both. So, if your financial situation has complexity and they're trustworthy, but they're not competent, then that's not going to work. Then speaking about the healthcare proxy, you definitely don't want somebody that's overly emotional, someone who may not be able to make the tough decisions that may need to be made in a very quick fashion. You would also want someone who knows your wishes in regards to your healthcare well,
Oscarlyn Elder:
If I'm ultimately the grantor of this power to the folks who fill the role, how do I go about telling them that I've given them these roles? I want you to serve in this role and here's why I'm choosing you and here's how I would really like for you to think about the decisions that you may be faced with. Best advice around that.
Jacqueline Parks:
Well, for many of our families, we recommend hosting a family meeting where you can get everyone together in the same room, get them on the same page. You're able to communicate, "This is my plan that I have laid out, and here's who I'm naming for these various powers and responsibilities." It gives the recipients of those powers the ability to ask questions, "Well, what do you mean by this?" Or "Why did you pick me or why didn't you pick me?" You can get those conversations going, but the main thing is to just communicate with the family. That family meeting doesn't have to involve discussions of any financial documents. It doesn't have to go into detail about who inherits what in the future, but just saying, "These are my intentions during my lifetime if I'm incapacitated."
Oscarlyn Elder:
It should not be a surprise to a medical power holder that they are that, and it's just really important. Tony, what would you add?
Tony Bryan:
Jackie said it perfectly. It's very helpful if you have somebody like a financial advisor or another some kind of advisor to do it that's not part of the family to facilitate that meeting. That's very, very helpful.
Oscarlyn Elder:
Yeah, so it's helpful to call in a trusted resource, especially if there's complexity to the family dynamic-
Tony Bryan:
Absolutely.
Oscarlyn Elder:
... to help hopefully keep the conversation focused to also have some skills and de-escalation, should there be some escalation around your choices or your wishes or your preferences,
Tony Bryan:
Yes.
Oscarlyn Elder:
But my guess is that one thing that will come up in these conversations a lot is, “I don't want to go to a nursing home. I want to stay in my home.” That's completely understandable. I know we all hear that quite a bit, but what's involved in making that vision, that dream, that goal? What's involved in making that possible?
Tony Bryan:
What really sticks out for me is making the home safe and accessible, which just on the surface it sounds incredibly simple. But it's actually incredibly complicated. What I mean by that is every room in the house is going to need to be evaluated for safety along with the outdoor space, and what makes it complicated is it's going to have to happen on a continuous basis because someone's condition is going to change and needs will change.
Jacqueline Parks:
I think that wanting to stay at home is totally understandable, and our listeners should understand that making it work does take real planning. As Tony mentioned, the house might need safety modifications, but you're also likely going to need to hire professional caregivers at some point for medical support, perhaps for daily tasks or even just for companionship. That kind of care can be expensive, and there's usually turnover in the individuals providing the care. You also have the additional risks and liability and potential for fraud. If you're bringing additional individuals into your home, you have to think about transportation, home maintenance, what happens if the obligations of caring for the home become too complex for you? In some cases when you add it all up, a good assisted living community may be actually safer and more cost-effective than modifying the home and hiring all these individuals to provide the care for you.
Oscarlyn Elder:
It's almost like you need someone within your structure to provide a healthcare management logistics oversight role. And we've seen this in families where often there is a child that takes on the role of scheduling caregivers, finding caregivers, which has become just incredibly complex in the post-COVID world. I'm just envisioning that there's this other role that develops if you're staying at home, and we need to be aware of that and plan for it.
Jacqueline Parks:
If I could add?
Oscarlyn Elder:
Yeah.
Jacqueline Parks:
Even if your primary goal is to stay at home and perhaps you've modified the home to make it safe for you, it is still wise to explore what other options exist in your community so that you have a backup plan if something changes. I work with a woman who she just did this for her father. He's a retired physician, and as she was researching local facilities, they discovered one where another retired physician with the same specialty had just moved in, and this was giving her father an immediate sense of connection. So, his plan wasn't to go there, but when they found out that this other individual had just moved in, he was more excited about it. He also loved gardening, and the facility had a beautiful garden that the residents could help maintain if they wanted to. He was no longer able to maintain his garden at home, but he could do a little bit at this facility. And for him, that just made the idea of moving feel like less of giving something up and more like he was gaining a new kind of independence and a new community.
Oscarlyn Elder:
That's a beautiful story and really points to, again, the different ways that families and individuals make decisions. Maybe one of the hardest conversations if it happens is around dementia or Alzheimer's. We may see diminishing mental capacity in a parent or an older relative before they see it in themselves. What are some signs it's time to take action and how can we broach such a really difficult, hard subject and what are the implications for other long-term planning?
Tony Bryan:
Some of the signs that stick out for me, I had a client who continued to ask the same question over and over and over again, so that one sticks out for me. Also, my father-in-law, he had some dementia and he would call my wife. He would be lost in the same town he's lived in for many, many years and he would be lost. Like, "I don't know where I'm at," he would call and say, "How do I get home?" Having trouble doing routine tasks like brushing your teeth or taking a shower, those are some of the things that stick out to me.
Oscarlyn Elder:
Tony, in those situations, were there conversations that started once your family noticed some of these signs? And I'm asking you to be vulnerable and share. If you don't want to, that's perfectly fine, but how do we go from the observation to the conversation?
Tony Bryan:
I'm happy to share. We tried to have conversations, and they just didn't happen. I would try to bring it up and my wife, we would try to bring it up and talk to everybody and we would just get shut down, so it didn't go well.
Oscarlyn Elder:
In those situations where there's not receptivity to the observations, and there isn't an immediate intervention, often those situations escalate into where there is no choice but to intervene to a place where there's such severity that it calls for immediate intervention, and that can just be more difficult on everyone.
Tony Bryan:
Absolutely. And that's where family relationships get strained or even worse get destroyed.
Jacqueline Parks:
As we age, a little bit of forgetfulness, a little bit of repeating the same story is very natural and normal. With my own parents, we just agreed that at their next regular physical, they would bring up this subject with their doctor because I'm not a medical professional and I don't know if what I'm seeing is normal. So, they agreed that they would do that, and I thought it was a respectful way to start the conversation centered around their own health. It's guided by their physician whom they trust and didn't feel threatening or accusatory. It's just saying, "Hey, we want to check in on you and make sure that everything is okay. Let's talk to your doctor about this." I do think it's important if you do begin to see the signs that you, again, have this planning type conversation and make sure that documents are in place because if they get a diagnosis or if their cognitive decline progresses to a point that they cannot make legal or financial decisions, then again, options and doors may be closed to you if they can't sign new documents legally.
Oscarlyn Elder:
Very good point to remind folks of that. What I hear in both of your voices is like such respect and care for the folks who are experiencing the decline, and I come back to also thinking about a loved one in my life and the family that supported him through his journey and such admiration and respect for this loved one. He was in a situation actually where he didn't experience as much cognitive decline. It was more physical decline, and it was so incredibly frustrating to him. But there were elements of his independence that he wanted to preserve for as long as possible, and the family was able to figure out how to support him on that journey. And of course, everybody's scenario is going to be unique. We can't just copy and paste out of the playbook or out of anybody's book. There's got to be flexibility and nimbleness with all of us to walk through this time in life.
And so, there are lots of factors at play. We know it can be really daunting to try to tackle them all, but ultimately, part of our message today if you are the listener, is that you really have agency over your future. And we have to own our own futures because we can be living a really long life. We know more people than ever are living to a hundred, and so it is just really important that we own this as much as we possibly can, that we communicate with the people that we love the most, and that hopefully we position ourselves in the best way possible to live out a long life with the vision that we have, preserving the elements that are most important to us. With that, when we come back, we're going to have a few final thoughts with our guests.
Tony, we've given people a lot to think about here today, and we don't want our listeners to come away feeling completely overwhelmed. What's the first step that you would recommend someone taking today if they want to start on this element of financial planning, this journey around financial planning?
Tony Bryan:
Well, first, feeling overwhelmed and feeling uncomfortable, those are normal feelings, so that is definitely okay to feel that way. And I know this may sound self-promoting, but I would say a good first step would be to speak to their financial advisor. And if they had a financial advisor who's not talked about this subject and only wants to help with investments, then they may need a new advisor. But I'll say that financial advisors will want to help you through this, and they may have a network of additional professionals to help you through this as well, because it does take a team.
Oscarlyn Elder:
Absolutely. It definitely does take a team, and Tony, we talk about it a lot on this podcast, like the value of really a third party, if you will. In this case you're talking about a financial advisor, but someone who's well positioned to ask really probing questions and to listen and to help you think through the complexities of what may be ahead. It's that person who can hold up a mirror to the situation and maybe help bring deeper clarity to you, but without some of the deeper family emotional elements that come out when a family member maybe is talking about those elements and trying to help you through a process. Then the advisor also is uniquely positioned to also help you see through a new window, to open up a new perspective that maybe you haven't thought about before. And that really captures, I think, what you're talking about, kind of that value and that relationship and navigating these waters forward. So, thank you for that.
Tony Bryan:
Absolutely. Thank you.
Oscarlyn Elder:
And as we wrap up here, one more question for you, Jacqueline. We have a tradition of asking our guests what's the one thing that they've been meaning to do that they haven't done yet and that they're willing to commit to do now? With our audience listening, what comes to mind for you?
Jacqueline Parks:
Something I've been meaning to do and now will commit to do is finalizing the next step in my own parents' long-term care planning. We have made great progress together, but we haven't yet shared that plan with my siblings. So our next step is to schedule that family meeting and walk through the plan as a group.
Oscarlyn Elder:
Jacqueline, that's a very important to do, and you've been on the podcast before and you had a really important to do if I remember. It involved your children are now adults and you wanted to revisit your estate planning and revise it because you're all in a different stage of life. I think in a conversation that we've had, it's a thumbs up on that. You've accomplished that. Am I right on that?
Jacqueline Parks:
Yes, that's correct.
Oscarlyn Elder:
So you've gotten that item checked off and now you've got this other very critical item that you need to do. So, we look forward to hearing more as you're willing to share, but we look forward to hearing how that journey unfolds for you and your family. And we certainly wish you all the best in those conversations, so thank you for sharing that.
Jacqueline Parks:
Thank you.
Oscarlyn Elder:
Jacqueline and Tony, thank you so much for joining me today. We're going to welcome you back to talk about some of the practicalities and legal necessities of long-term care planning on our next episode, and I'm really looking forward to that conversation.
Jacqueline Parks:
I am as well. Thank you, Oscarlyn.
Tony Bryan:
Thanks for having me.
Oscarlyn Elder:
Listeners, just a reminder that we talked about some of the financial elements related to longevity planning on an earlier episode, and I really encourage you to listen if you haven't. You can find that episode at truist.com/dothat. And I want to thank you for joining me today. If you liked this episode, please be sure to subscribe, rate and review the podcast and tell friends and family about it. If you have a question for me or suggestion for this podcast, email me at dothat@truist.com. I'll be back soon for another episode of I've Been Meaning To Do That, the podcast that gets you moving toward fulfilling your purpose and achieving your financial goals. Talk to you soon.
IAR disclosure: Oscarlyn Elder is an Investment Advisor Representative, Truist Advisory Services, Inc.
Any comments or references to taxes herein are informational only. Truist and its representatives do not provide tax or legal advice. You should consult your individual tax or legal professional before taking any action that may have tax or legal consequences.
