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Aug. 25, 2022

Howard Gleckman - Caring for Our Parent and for Ourselves

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Howard and I have an essential discussion about aging in America. We talk about the lack of a long term care system in the United Staes as opposed to other countries, aging at home vs. senior living facilities, and how to know when we should be talking to our parents and deciding for ourselves when it's time to consider alternate housing and how to accomplish the change.

Caring for our Parents - the Book

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Disclaimer: AI Unedited Transcript

Announcer (00:06):

You are connected and you are listening to specifically for seniors, the podcast, for those in the remember when generation today's podcast is available everywhere you listen to podcasts and with video specifically for seniors, YouTube channel. Now here's your host. Dr. Larry Barsh

Larry (00:39):

Today's podcast is a difficult one for those who are our age, but it is an important one. The subject is one. We will all probably experience for our parents or ourselves as we age. My guess today is Howard Blackman. Howard is senior fellow at the urban Institute where he's affiliated with the tax policy center and the retirement policy program. He's the author of a new book, caring for our parents, inspiring stories of families seeking new solutions to America's most urgent healthcare crisis. Before joining the urban Institute, Howard was correspondent in the Washington bureau of business week. He's written for the Washington post Forbes and USA today. Welcome to specifically for seniors, Howard.

Howard Gleckman (01:38):

Good to be with you, Larry.

Larry (01:40):

Thanks for being here in your book, caring for our parents. You start with your, and your wife's story about caring for your parents. Can you introduce the listeners to the book and what your experiences were?

Howard Gleckman (01:58):

Sure. I was a journalist, as you said, in the introduction, my wife was a lawyer. We both were sort of in the business of asking questions and kind of knowing what we were doing. And one evening I'm sitting at home reading a book, listening to music, and my wife is out at some meeting and the phone rings and it's my father-in-law. And he's calling from a hospital in Florida to tell me that my mother-in-law has had a stroke, and he has no idea what to do. And that phone call changed my life. We the next first thing I had to do of course, was figure out a way to tell my wife what had happened. We got a plane the next day got to Florida discovered that my mother-in-law had a very severe stroke and was on life support. And my father-in-law had advanced cancer, which they hadn't told anybody in the family about.

Howard Gleckman (02:47):

We had to first make a decision to take my mother-in-law off of life support. And then we had to figure out how we were gonna care for my father-in-law. We all made a decision together that the best thing for him to do was to move to the Washington area of Maryland, where my wife and I lived, so we could take care of him for the last days of his life. And while we were doing that, we had just sort of got him settled. I got another phone call from Florida, from my parents telling me that my father was in the hospital of congestive heart failure. And we then had to figure out a way to care for him, for what turned out to be about 18 months of his life. My mom and an a were able to care for him.

Howard Gleckman (03:25):

So he stayed at home. And I learned a couple of things. That first thing I learned is how incredibly difficult it is to be a caregiver. And the other thing I learned was what a mess our long term care system is. It's not connected in any way, really with our healthcare system doctors can't tell you anything about long term care or the supportive services you need. The financing is completely different. Health insurance doesn't pay for any of this Medicare doesn't pay for any of this mm-hmm <affirmative>. So I eventually changed careers wrote this book that you mentioned and wanted to work for the urban Institute where I do research in the world of, of empire, the world of long term care.

Larry (04:09):

Let's start by defining what long term care means, what it is.

Howard Gleckman (04:14):

So let me start by saying what it isn't, it's not medical care. It, it is the supports, the social and personal supports that somebody needs. Somebody with chronic disease needs to live the best life they can that may be a home health aid. It may be an adult day program. It may just be somebody helping you balance your checkbook or going to the grocery store. It's that whole range of social supports that people need as they become frail at old age. And about 70% of us are gonna need a significant level of that care. Before we die there, some of us will get hit by the proverbial bus. Some of us like my mother-in-law will have a stroke and die, but for the most part, we will live long, healthy, relatively active lives until we become too frail and something will happen and we'll need help.

Larry (05:09):

And in this country, the long term care quote unquote system is failing us

Howard Gleckman (05:18):

Completely, both the, both the financing system and the delivery system. You talk about both of them, cuz they're, they're different with different problems, but both of them have failed. So the financing system such as it is, you essentially pay for it yourself until you go broke. And then you go on the Medicaid. And when you go on Medicaid, you're guaranteed a room in a nursing home. You may have to share the room with a complete stranger, that it may be a terrible nursing home, but you're guaranteed a room in a nursing home. And in every state you're guaranteed some what they call home and community based services, which is some home care. But that varies a lot from state to state. It's all a welfare based income based system. The United States and England are the only developed countries in the world that don't have a social insurance program for long term care.

Howard Gleckman (06:13):

Every other program, whether it's every country, whether it's Singapore or Israel or France or Germany has a well developed social insurance model. Essentially what happens is you pay a payroll tax while you're working. And then when you need this care, you get insurance that pays for at least a fraction of the care you need. The United States. We don't do that. You only get government based care Medicaid when you're poor enough and sick enough. And when I say poor, I mean really poor. You have to have assets of less than $2,000 and you have to have income of less than a thousand dollars a month. So essentially you've gotta be debt broke before you're eligible for this program.

Larry (06:57):

So it's even less than social security provides.

Howard Gleckman (07:01):

Yeah. For a lot of people,

Larry (07:05):

What are other countries doing countries like Japan, the Netherlands.

Howard Gleckman (07:11):

So they're all a little different, but they all have something in common. So as I mentioned, basically, the way they work is you pay a payroll tax like we do for social security and Medicare. You pay an additional payroll tax and in some countries it's 1% of, of, of wages in some countries. It maybe is as much as eight or 9% Netherlands. It's 10% of wages. And in return for that, when you need a high level of care, you need support doing bathing or eating or getting to the bathroom. This program automatically kicks in and you get a benefit in some countries, it's a cash benefit. So works a little like social security. You just get cash and you can spend it on whatever you want. If you need a wheelchair ramp, you can buy that. If you need an aid, you could hire an aid.

Howard Gleckman (08:02):

If you wanna hire your next door neighbor or your niece, you can do that. In other states, it's, it's more like private long-term care insurance in the United States. It's a reimbursement model. You pay for approved care and you get reimbursed for that. So in, in some places it's cash benefit. In some cases, it's a service benefit. You don't ever see the cash. The government just pays for the service, whether it's in a nursing home or whether it's a home care program in some countries like Germany, you get a choice. You could either get cash or you can get services in Japan it's only a service benefit. There's no cash in France. It's only cash. There's no services. So it varies a lot. But basically the model is you pay payroll taxes while you're working and you get this benefit when you need it.

Larry (08:50):

Mm-Hmm <affirmative>, there was just a, an article in the Boston globe about the Netherland system is that different.

Howard Gleckman (09:00):

So the Netherland system is very different. And let me again, break it up into two pieces. I'll talk about the delivery system. And then the financing system finance system is social insurance. It was until 2015, an incredibly generous program. And it was so generous that the system was going broke. The country was going broke and not so much because of older adults who needed the care, but younger people with disabilities who were getting years and years and years of very expensive institutional care. These are people with developmental disabilities like autism and down syndrome or something like that. And it was turning out to be incredibly expensive. So in 2015 the Netherlands revised the financing system. They broke it up into pieces. Now people with disabilities get one kind of benefit, older adults with a high level of need and different benefit. Some of the benefits instead of being provided by the federal government are provided by the, their equivalent of state governments and the amount of of a, that you, of support that you get has been reduced a little bit, but it's still a very generous benefit.

Howard Gleckman (10:04):

And you get it by paying about 10% of of, of, of wages up to about $35,000 in payroll tax. When you need the care, is it older adult? The, the system pays for about 90% of the care and you pay for about 10% mm-hmm <affirmative>. So that's the financing system that very generous financing system has developed a fascinating new delivery system. So in the United States, let's take somebody with dementia, obviously, a very common need among older adults. What do we do? We lock you up in a memory unit of an assisted living facility or a nursing home. You have very little ability to move around. There's not much for you to do. It's not a great system in the Netherlands. What they've done is they've created almost these little villages so that people have maximum flexibility. They can go into little stores, they can go into restaurants.

Howard Gleckman (11:00):

As that global article said, they can't go to art museums necessarily, but the art museums bring art to them. A whole range of programs. They can't leave this community, but within the community, they're free to walk around. And what they've discovered is that people given that autonomy are much healthier than they are in the United States. In the United States. We worry so much about things going wrong. We take away people's freedom and, and all of us would like a certain amount of autonomy. You know, in the United States, they have this, this model called greenhouses, which are much more flexible kinds of small nursing homes. And one of the big differences between a greenhouse and a traditional nursing home is a traditional nursing home. Somebody comes to your room at seven 30 in the morning, and they say, Larry, it's time for your bath, whether you want a bath or not, you may wanna sleep in that morning, just like some mornings I wanna sleep in mm-hmm <affirmative> can't do it in a traditional nursing home, cause that a has got 10 people.

Howard Gleckman (12:03):

She has to bathe between seven 30 and eight 30. And you're gonna get up and you're gonna get your bath, whether you like it or not in the, in the Dutch system and in greenhouses in the United States, that's not how it works. You say to the a, you know, tomorrow morning I wanna sleep in, you know, gimme my bath at 10 o'clock. I don't want it at eight o'clock. And they say, okay, not a problem. So that very regimented system that we have in the United States is very different over there in the United States. We're terrified that people are gonna fall in the Netherlands. They say, we're gonna give you some autonomy. You fall, you fall, it's up, you know, it's up to you. You make a decision, you wanna take a risk. And just like me, I take a risk. I go skiing. I fall, I took my chances. I fell. So the, the there's a recognition that even if you're old and even if you may have some cognitive impairment, you have the right to make decisions for yourself. And that's a, that's a big cultural difference between what they do in the Netherlands or what they do mostly in the United States.

Larry (13:06):

Is there more societal responsibility in the Netherlands, for example, and there is here.

Howard Gleckman (13:16):

Yeah. You know, there is almost everywhere in the world. The, there is in, in all of Europe, particularly in Northern Europe, but really in all of Europe in parts of Asia, certainly in, in middle Eastern countries like Israel, there is, there is this sense of social solidarity that we all are in it to help one another in the United States. You know, we think of ourselves as kind of the John Wayne figure. You know, I'm, I'm out there by myself, riding my horse in the wild west, and I'm not gonna take care of anybody. And I don't have any expectations that anybody's gonna take care of me. And that's unfortunate. And, and you know, again, we have exceptions, we have senior villages, we have other models in the United States where people do care for one another. But for the most part, that sense of social solidarity just isn't here.

Larry (14:04):

And that's not getting any better.

Howard Gleckman (14:07):

No, not at all, not at all. You know, I, I do a lot of work looking at ways that communities can help support one another. And sometimes they're faith communities, sometimes they're churches or synagogues or mosques where people can get together and help one another. And in the places that do it, it actually works quite well. There are these senior villages in the area that I am in Washington DC area, there are probably 40 or 50 of them. And they're community based, not for profit organizations where people help one another. So if I need a ride, I notify a central office that I need a ride to the doctor at 10 o'clock tomorrow morning, you may have time and you let the central office know you're available to drive me. And, and that's what you do. You give me a ride. If you need companionship, you just need somebody to come visit one afternoon. I put down that I can do that. I come over to your house and we play cards and shoot the breeze for, for an hour. So there, there, there are these kinds of models that are developing around the country, but there, there are few and far between,

Larry (15:11):

Is Congress doing anything?

Howard Gleckman (15:13):

Huh? So <laugh> sorry about that. What's the next question. So when COVID happened and, and you know what COVID was 700,000 older adults died from COVID 200,000 residents and staff of nursing homes died from COVID. I thought that Congress finally would take some steps to fundamentally change the long-term care system. I thought that that crisis was such a catastrophe and it was so big and it got so much attention that Congress would finally act while at 2020 Congress did pass one bill that expanded home and community based services under Medicaid by about $12 billion for a couple of years. So that provided a little more benefit. Mostly what it did was it was mostly, it was used to pay the aids a little more money. President Biden proposed 400 billion in additional home and community based services under Medicaid over the next 10 years. There are also proposals to improve nursing home care. There are also family leave programs so that families could take time off and, and care for older adults were for other family members. None of that passed. All of those provisions were, were dumped from this bill. It just passed a couple of weeks ago. So essentially other than that one temporary increase in Medicaid funding. Congress responded to this extraordinary historic crisis for older adults, that was COVID by doing nothing.

Larry (16:54):

So the bottom line in this country is we've gotta help our parents to take care of themselves. And we've gotta plan for our own aging.

Howard Gleckman (17:08):

Yeah. I mean, thi this, this may somewhere down the road change, but right now my message to people essentially is you're on your own. And you gotta plan for it. I mean, long term care is incredibly expensive. A nursing home costs a hundred thousand dollars an up depending on where you are, home care an aid now costs easily $30 an hour. There's such a shortage of aids that they are now demanding more pay, which they want to get. And by the way, when you pay an agency, $30 an hour for a home care aid, the aid's only getting about half that the A's only getting about 15 now, less, the agency's getting the rest

Larry (17:50):

Less, but

Howard Gleckman (17:51):

So, you know, the aids are not exactly rolling and do. But they are getting a little more money than they used to $30 an hour. Think about it. If you need eight hours of help a day, that's over $200 an hour, $200 a day. It's a lot of money and most people don't have it. So what do you do? You need to plan for it early when you're in your thirties and forties, you need to start saving. And you can't be in denial. You gotta, you gotta understand. I said, you got a 70% chance of needing this help. So you better do something. You just save for it. Or maybe you have home equity that you can use sell your house or get a reverse mortgage or something like that. Or you can buy private long term care insurance. Not many people do that these days, but you can do that. Otherwise you just spend what you got and when you're broke, you go onto Medicaid.

Larry (18:48):

You said not many people get long term care insurance today. Is that because of cost or just

Howard Gleckman (18:57):

Yeah. It's, I mean, there, there are a number of sort of subsidiary reasons. It's people have trouble understanding it. They, they, they don't have foresight. They, you know, Americans don't have a lot of foresight. They can't think about what it's gonna be like when they're 85 and need help. Mm-Hmm <affirmative>. But the main reason is it's just too expensive. A policy now, a decent policy now costs $3,000 and up a year. And people don't have that money. You think about it. If you're in your forties, you're probably just now starting to think about putting a kid through college. You've got a home mortgage, you've got car payments, you've got health insurance to buy. Maybe you've got your own student loans. You're still paying off. You've got this long list of stuff you need to do somewhere at the end of that list is long term care for when I'm 80 and, and it, people just don't get to it.

Howard Gleckman (19:49):

They don't do it. You know, I, I, I used to before COVID I used to talk to consumer groups all the time and, and you know, this would come up. People would say, well, I don't need to buy long term care insurance. I can just save for it. And they say to them, you're right. You could, you won't, but you could. And, and that's the, that's the problem. We don't save private long term care insurance, you know, in theory is a great idea. But in practice, it's just become too expensive. Insurance companies don't wanna sell it because it's, it's so risky for them. 15 years ago, there are a hundred companies that were selling long term care. Insurance now is about a dozen. And people don't wanna buy it last year. 50,000 people in the entire United States bought standalone long care insurance.

Larry (20:33):

Really? Yeah,

Howard Gleckman (20:34):

More people bought what they call combo or hybrid insurance, where they combine it with an annuity or whole life insurance by a few hundred thousand people bought those policies, but to buy an annuity, most people can't can't afford those. Those are, those are really for upper income wealthy people. Mm-Hmm

Larry (20:52):

<Affirmative>. Can we talk about the advantages and disadvantages of aging at home as opposed to a senior living facility?

Howard Gleckman (21:05):

Sure. So often advocates will say, there's no need for nursing homes. You know, burn 'em all down, turn 'em into parking lots. We never need a nursing home. Nobody should review a nursing home. Well, the reality is there are some people who need to be in a nursing home. There are other people who need to be in assisted living or in small group homes or in other kinds of concrete care. Imagine you are an 85 year old widow with cognitive impairment, no children around. There's no way you can take care of yourself in your own home. There's no way even if you have the money to hire aids, what happens when the aid doesn't show up and the age sick, you're gonna have to organize a replacement for her? Well, you've got cognitive impairment, you've got some dementia. You can't you could be a danger to yourself, you know, you could leave the stove on.

Howard Gleckman (22:00):

So there are a lot of people who, because they don't have a family caregiver and take care of them, or because of the nature of their disease, they simply cannot take care of themselves at home alone. So they need some sort of facility based care. Now, the question is what kind of facility? And, you know, there are lots of options. There are nursing homes or assisted living facilities. There are continuing care communities where you get independent living and assisted living. And sometimes a nursing home. There are these small group homes which can be terrific. All sorts of options if you're can afford them. I was three or four weeks ago, I was visiting a small group home for people with a fairly advanced dementia, wonderful place kind of place where I would like to be if I needed that kind of care, $13,000 a month, mm-hmm <affirmative> you know, talked to the woman who ran it.

Howard Gleckman (23:04):

She's great. She, how does it cost $13,000 a month? She walked me through how it costs $13,000 a month. 60% of our costs are labor costs are the cost of the staff. So if you have the money, there are options out there, but most people just simply cannot afford that. So they need some kind of a facility. Medicaid will only pay for room and board in a nursing home in a skilled nursing facility that won't pay for room and board assisted living. They mostly won't pay for care in assisted living. So what that means is if you need facility based care, you pretty much have to go to a nursing home, even though you really don't need skilled nursing care. It's, it's needlessly expensive, and you have to deal with these hospital like rules. Like you can't get up when you want to. And all of that.

Larry (23:55):

Yeah. How do we know when our parents sh when we should start to convince our parents? Well, for me, it's, it's on the late side for that.

Howard Gleckman (24:08):


Larry (24:10):

How do we know when we should start prepping them for moving into a assisted living facility, even into an independent senior living facility? Right?

Howard Gleckman (24:23):

So the short answer is sooner than you think, right? But what, what most people do is they wait until a crisis hits. They wait until something happens like with my mother-in-law, she had a stroke. What would've happened if she recovered from that stroke, we would've been in an absolute crisis at some point, the hospital would've said, well, she can't stay here anymore. Medicare's not gonna pay for any more time in the hospital. She gotta go. Discharge planner says, you know, gotta go by noon today. What do we do? What do we go? No idea. 

Howard Gleckman (25:01):

Ideally in a perfect world, this is what would happen, parents in it before parents are suffering from frailty of old age, parents sit down with their children, with their adult children, and they have a conversation. They have an honest, upfront conversation about what it's gonna be like, should something happen to me, or when something happens to me where am I gonna live? If I have several kids, which kid am I gonna live near? Or with how's that gonna go? You know, is Johnny gonna be able to take care of me or is Sue gonna take care of me? How are we gonna do that? And ha have those conversations. And don't just have the conversation once, have it over and over again, because things change. But, but, but just keep talking about it. I would say probably people probably begin having these conversations when their parents are in their sixties, which probably means they're only in their thirties or forties mm-hmm <affirmative>. But denial is the worst enemy of us. All. It makes it impossible for us to plan for, for financially planned for our own care. And it makes it impossible for us to begin to plan for our parents' care, so that we're ready when the crisis hits. And, and we just, we don't wanna have that conversation, which is, it's just too hard.

Larry (26:30):

So now the most difficult question of all, I guess, is how do we get over our own deniability and know when it's our time before we get sick before we get I, well, I shouldn't say before we get sick, because in eighties you've got something. Sure. how do we know when it's time for us to start thinking about making the move to an in living, continuing care type facility?

Howard Gleckman (27:07):

So, so I think there are a number of things to think about. I mean, it, it's hard to think about your own frailty. I mean, ideally we would say, you know, I'm having trouble getting up and down the stairs. I, I, you know, it just hurts every time I go upstairs to, to go to bed every, every night, I don't wanna do this anymore. But that's hard, but there are other ways to think about it. So for example, think about your friends. You know, are you, are, are you still able to visit your friends? Are your friends still, still able to visit you? And if you're getting a point where, you know, nobody wants to drive at night, for example you know, that's a point where you start to say, maybe I ought to think about moving into a community. You know, you think about your neighborhood often.

Howard Gleckman (27:51):

You know, you think about a very common story. You have a family that raises kids. You have a couple that raises its kids in a, in a neighborhood, kids move out, they're empty nesters. They stay in the neighborhood and they look around one day and they see they're 80 and, and the neighborhood's turned over. Everybody else in the neighborhood is 35. And they got, you know, five year old kids. And, you know, you don't know them anymore. You know, the idea of having your neighbors over for a drink, you know, those neighbors are gone. And you know, at that point, maybe you say to yourself, you know, maybe this neighborhood's not for me anymore. You think about the delivery of care. If you live in a suburban, cul-de-sac getting care to you, getting that aid to come to your house is very difficult. She's gonna be stuck in traffic for hours or on the bus.

Howard Gleckman (28:43):

So maybe this really isn't the most appropriate place to be. So I think at that point, you, you sort of think about your environment around you. Same thing with, with the faith community. You know, you, you, you, you were somebody who, you know, used to go to synagogue every Saturday or go go to church every Sunday or the mosque every Friday, and now you can't get there, like you used to. And maybe then you say to yourself, you know, maybe, maybe it's time. I'll tell you a story about my mom after my dad died. She called, she said, you know I I'm, I don't have any more friends. It's it's time for me to think about moving one, one bit of advice for people. I think you, you, for the adult children, I think you get in trouble. When you start a sentence with dad, you got to fill in the blank, you gotta move, you gotta give up your keys for the car.

Howard Gleckman (29:41):

You know, nobody wants to hear that. You know, when you're getting older, you know, the, the, the, the main thing you wanna do is maintain some level of independence and dignity. And when your kid is saying, dad, you've got to fill in the bike. You are immediately gonna react. Like, no, you can't tell me what to do. Who are you? You know? So what we did with my mother may work for other people. We said, so after my dad died, before she made this decision, we said, come up here and visit with us. And let's just look at some places, no commitments. We're not saying you've gotta move into one of these places, or even moved to our, to our area, just come and look at 'em and tell us what you think. So we looked at three or four places, and, you know, I said, did you like any of 'em?

Howard Gleckman (30:29):

And she said, yeah, there was one that I really kind of liked. I said, great. When the time comes, when you're ready, call me and we'll Sue, get you in. So that's what happened. She called me a year later and she said, you know I don't have any more friends. I'd like to move. And I called the place and they had a waiting list of a couple of months, but we got her on the waiting list. And we moved her in and it turned out to be a great decision for her. And for us, she was two miles from our house. Mm-Hmm <affirmative>. And so, so the point is, I think make the, if you're an adult child listening to this, make your parent part of the conversation and part of the decision making don't make the decision for them, cuz it'll never work.

Larry (31:15):

And if you're an individual adult senior, make the decision for yourself when it's appropriate.

Howard Gleckman (31:23):

Yeah. And, and the, and the, the worst phrase, there are two terrible phrases. I hear all the time in this world. One of them is I didn't wanna worry the kids that, that, that, that's usually what you say when it's too late, right? The other one is the phrase, parenting your parents. And the truth is if you're an adult child, you're never gonna parent your parents. You may be taking care of them. You may be doing very personal care for them. Maybe bathing them. You may be getting them to the bathroom, but you're never gonna be their parent. They're always gonna be your parent. And, and I think it's really important that the parents don't put themselves in a position where they're saying, I didn't wanna worry the kids and the kids aren't in a position where they're, they're sort of taking control of their parents' lives, cuz both of those are bad situations.

Larry (32:19):

And as an 86 year old, another phrase comes to mind parenting yourself,

Howard Gleckman (32:27):

Parenting yourself. Yeah. Yeah. So now, you know, it's, it's, you have some responsibility, you think about it as an older adult, it's kind of the last responsibility you have to your own children is to don't put them in this situation where the crisis has happened and now they've gotta make these decisions. Yeah. You know, it's the last kind of good thing you can do that. That's true. When you think about things like living wills and advanced, certainly cuz you never want to put your, your kids in a position where you're, you're, you know, comatose in the hospital and they have to make a decision about what's gonna happen to you at end of life, without any information about what you want. You certainly don't want that, but even short of that, even when it's the kind of situation you're talking about, where nobody's dying, but they need more help than they, than they can manage. Now. you don't wanna put them in that situation either. You want to give them the opportunity to know what it is you want and, and, and, and therefore they can work with you so that you can you can fulfill that wish.

Larry (33:38):

Is there anything else we should be talking about?

Howard Gleckman (33:41):

<Laugh> a lot. No. I mean,

Larry (33:44):

In this

Howard Gleckman (33:44):

Regard. Yeah, no, I, I think, I think in this regard, those are really the things. I mean, I, I it's it's it really does boil down to honest communication. Talk about this stuff, talk about the money. Nobody wants talk about the money. But you need to talk about that. How much does mom and dad do they really have? And, and what's a realistic care situation that we can buy into for them. Do the kids have enough resources that they can help their parents or not. And again, have an honest conversation, you know, Johnny May say, look, I, I, I'm struggling here. I got, you know, one kid in college and two more on the way. And I, I just don't have the money to help you mom. And, and that's fair. I mean, that's, that's the reality of it, but have the conversation assume you know, don't, don't pretend that some, the money's gonna come from somewhere, you're gonna hit the lottery.

Howard Gleckman (34:45):

It's probably not gonna happen. You've gotta make the plans. And, and the only way to do that is to have that conversation. I, one of my heroes was I, I, once a few years ago was giving a talk at a synagogue. And after the talk we were having lunch and a woman came up to me and she was quite elder. She was probably in her nineties. And she said, let me tell you what I did. I said, what's that? She said, I got three sons. And she said, I called them. And I said, we're all having lunch. Okay. We all had lunch. And she said, I sat down and she said, so this is what we're gonna do. Okay. And it was everything from who gets the car and who gets the house to, this is where I wanna live. And this is how I wanna live.

Howard Gleckman (35:31):

And this is how we're gonna do this. And I thought, you know, I'm gonna take this woman with me every time I give a talk because you know, that's what you gotta do. You gotta, and, and sometimes the, the conversation is gonna come from, it's gonna be instigated by the parent. And sometimes it's gonna be instigated by the kids. And sometimes the kids are gonna be worse in the denial than the parent. They're gonna say things like, oh, mom, you're gonna live forever. You know, no, mom's not gonna lie forever. And and the kids gotta get over it. They gotta understand that. So sometimes the denial is on the parents' part and sometimes it's on the kids' part and you gotta fight through it.

Larry (36:09):

Howard, this has been invaluable. This guidance for the listeners is just terrific. Really? Thank you so much for coming on specifically for seniors.

Howard Gleckman (36:24):

My pleasure. It's good to talk to you anytime.

Larry (36:26):

Thanks again. Thank you

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Howard Gleckman


Howard Gleckman is a senior fellow at the Urban Institute, a non-partisan think-tank in Washington, DC. He is the author of the book Caring for Our Parents and writes a regular column on aging policy issues for Forbes.com