Time to Talk

Beth Witrogen McLeod knew something was wrong when she stepped into her parents' Wichita, Kan., home. Her mother smelled bad and her clothes were dirty. The normally immaculate house was cluttered and filthy, the floor spotted with food stains. McLeod later realized her mother, who suffered from Lou Gehrig's disease and early-stage dementia, had been trying to bring food to her cancer-stricken husband but often lacked the strength to handle the tray.

Thus began McLeod's yearlong struggle to care for her parents, an experience that wiped out her savings and that of her once-successful mother and father. Only death spared the elderly couple from bankruptcy; they died within weeks of each other after being moved to a nursing home. Because of poor planning, life insurance proceeds and retirement savings that could have gone to McLeod went to pay creditors and lawyers' fees.

Bay Area resident McLeod, who wrote about her experience in the new book "Caregiving: The Spiritual Journey of Love, Loss, and Renewal," knows now that at least some of the emotional and financial pain could have been spared had her family discussed some important issues of aging: estate planning, health care and dealing with incapacity.

But before the crisis, both parents and child resisted.

"They were immortal," McLeod, 43, said wryly. "My father told me he was going to live forever, and I believed him."

Denial, busy lives and reluctance to confront difficult issues keep many families from having these discussions, elder-care experts say. Parents can see their children's efforts to broach such topics as attempts to take control, while the adult children may shy away from intruding into their parents' lives. Money issues can be particularly touchy. So both sides put off asking and answering questions.

"Often it's, 'We're going to get around to it someday,' " said Marty Richards, a Seattle social worker and geriatric-care manager with 32 years' experience in aging issues. "Then the crisis comes and they're not ready."

The issue of long-term planning is a particularly pressing one for baby boomers, who stand to inherit trillions of dollars from their parents but who may also become increasingly responsible for their elders' care as people live longer and government care systems become strained.

So far, many boomers have been able to all but ignore parental aging, thanks to their elders' relatively good health. Three-quarters of those age 65 to 74 who aren't in a nursing home or hospital rated their health good to excellent in a 1992 study, according to the U.S. Census Bureau. The proportion of older people who rate their health good to excellent has remained about the same since the 1970s, when the question was first asked.

Improvements in medical care and longevity mean that far more may live to a ripe old age. In 1940, only 7% of those aged 65 were expected to survive to age 90, Census Bureau statistics show. Today, more than 25% can expect to live that long.

With increased age come increased problems, however. The Census Bureau cautions that even with further advances in science and medicine, longer lives may mean higher rates of chronic illness, long-term disability and dependency. Living longer also means more people are expected to experience Alzheimer's and dementia, debilitating illnesses that can require 24-hour care.

Of those over 85, at least one in four lives in a nursing home, and many more need help with serious health problems. Other studies cited by the Census Bureau show that half of those over 85 need some help with basic living activities, such as dressing, using the toilet, preparing meals and housekeeping.

Clearly, more baby boomers will be faced with parents' declining health and increasing needs; McLeod likens the phenomenon to a tsunami whose first waves are now crashing ashore.

Many boomers will also be dealing with the costs and details of inheritance. High probate costs in some states, particularly California and New York, mean that even relatively modest estates can benefit from some estate planning. Estates worth more than a certain exemption amount ($675,000 in 2000 and 2001, but scheduled to rise to $1 million by 2006), are also subject to federal estate taxes that can go as high as 55%.

Lack of planning can be expensive, even with parents who have few assets. After her parents' death, McLeod discovered that her parents' will had not been updated since 1961 and that her father's life insurance policies and retirement savings named her mother as beneficiary. Since no contingent beneficiary was named, the money went into the estate, where it could be attached by creditors instead of passing directly to McLeod.

Because her parents hadn't taken steps to avoid probate, the estate languished in probate court for four years, which cost $12,000 in attorney's fees.

The attorney "was a good guy . . . but he wound up with a third of the estate, what was left of it," McLeod said.

Yet in some families, talking about money is more difficult than talking about sex--which makes estate-planning discussions painful to start, social worker Richards says.

"It's sharing information that they've [parents] kept very secret over the years," she said. "It's about power and control."

The fear of losing control has been cemented in many older adults by their experiences during World War II and the Depression, Richards said. Self-sufficiency is often prized, and any form of help is often frowned on--whether it's help from their children or from government-sponsored aid such as Meals on Wheels, respite care or other programs that can help alleviate a caretaker's burden. Some have trouble even contemplating the possibility that they may not be able to care for themselves someday, Richards said.