Question: Our mother (age80) and father (age 86) are both failing physically and mentally. Although I live closest to our parents, see them regularly, and try to take care of their needs, my brother and sister (who live in other parts of the country and come to town irregularly) and I cannot agree on what is best for our parents. These conflicts are causing breaches in our family relationship, and, at the same time, our parents are suffering. The three of us had a meeting with a lawyer who lost control of the situation and caused even deeper resentment. Do you have suggestions about how to break the logjam?

Answer: In working with elderly individuals and their families to create an effective long-term care plan, it is essential that the lawyer understand not only the unique needs of the elderly person, but also the intra-family dynamics. To be effective, the attorney must identify, assess, and address these issues as early as possible in the planning process because all long-term care planning is filled with conflicts.

These conflicts often include whether to preserve assets for beneficiaries or to use assets to fund long-term care, and whether the elderly person is comfortable giving up control of assets and, if so, to whom. If the elderly person is not comfortable with giving up control of assets, alternate planning ideas should be discussed.

Another area of conflict is "quality of care versus cost of care." Certainly, everyone wants the best care available for family members; however, as with any commodity, the more you get, the more it costs. Should the elderly person stay at home? Does he or she need residential care? Can a nurse or aide come to the house to assist? Can a wife or child take care of the elderly person? Does the elderly person need a nursing home? If so, how long will the funds be available? Can the cost of care be paid without causing the spouse who may remain in the community to become destitute? Will assets be sold to pay for the care? If so, what are the income tax ramifications and will taxes be offset by medical deductions in whole or in part?

Taking the NextStep: The attorney, the elderly persons, and the family must face the question of the elderly person's needs as opposed to his or her desires. Almost no one wants to be in a nursing home, but some people need to be in a nursing home. The elderly person’s perception of health issues and the ability of the family to provide care is often very different from the actual facts.

Elderly persons (if capable) and family members must determine what care can be afforded and still meet the family's other financial needs based on their unique circumstances.

The family must remember that providing the best care for the elderly person at the best price is the goal of the planning process. Unfortunately, this is not always clear and causes squabbles within the family that can be avoided if family members are educated and understand that someone needs to be in charge.