5 Geriatric Care Management Tips for the Sandwich Generation

The Sandwich Generation refers to a generation of people who are caring for their aging parents while supporting their own children. If you’re a caregiver in this generation you might liken the associated financial and emotional stress with the feeling of being “sandwiched” between the two responsibilities that are taking up most of your time.

Sandwich generation providers can create a care management sandwich that meets their needs and the needs of their aging parent(s) through effective planning, support, and advocacy.

5 crucial ingredients for a balanced care management sandwich:

  • Emotional well-being
  • Financial Planning
  • Healthcare
  • Career
  • Family

1. Emotional Well-being

For those taking on the greatest time commitment for providing care for an aging parent or parents and also trying to fulfill their own parenting obligations, finding time for self is an important part of maintaining balance in life. Caregiver burnout can seriously impact your quality of life and your ability to continue caring for your loved ones. It is essential that you carve out some time for yourself every day to do something for yourself. It might be a session at the gym, coffee with a friend, reading a book, or any activity that recharges your emotional batteries.

2. Financial Planning

Perhaps one of the biggest contributors to sandwich generation caregiver stress is managing the costs associated with raising children and maintaining the health of aging parents.

To help ease the financial burden talk to your family members and involve them in the financial planning process. Assess all of your financial resources and create separate accounts with allocated budgets for long-term care management and day-to-day expenses for the whole family. If this task seems too overwhelming, seek the help of a Certified Financial Planner that deals with long term care planning. Contact us to help find a specialist that meets your needs.

3. Healthcare

As your parents age, medical issues are likely to arise. Advance planning for possible physical and mental healthcare issues is key to effectively managing them. It is helpful for caregivers to visit and evaluate several long-term care facilities well ahead of the need for placement. Understand that institutionalization may be a normal progression in the process. Encourage the completion of a Durable Power of Attorney for Health Care form or an Advance Health Directive for Dementia in the event of your aging parent(s) being unable to make healthcare decisions for themselves at a later stage. Also see: Practical Advice on Caring For a Parent with Dementia5-step Geriatric Care Management Plan for Dementia Patients and the Families Caring for Them

Part of your planning should also include ways of keeping your aging parent(s) active. Involve them, as far as possible, in the day-to-day chores in the household and plan simple mental and physical activities like reading to the children, doing a crossword, going for a walk, joining a senior activity group etc.

4. Family

Multiple generations living together in one household can be stressful. There are so many voices that need to be heard, and often not enough time for everyone to have their say. Open, honest family communication is so very important for maintaining household balance. Try and set aside a time, perhaps around the dinner table, for each family member to talk about their day or share a personal experience. Plan a monthly family outing, even it’s in the back yard with a ball. Laugh together as often as you can and learn to sweat the small stuff.

5. Career

Juggling work-life balance is an art that requires a lot of planning and support – from your family and your employers. Don’t be afraid to ask your family members and colleagues for help if you need it, and you probably will. A geriatric care manager can also help you find the care management support and resources you need.

What is a Plenary Guardian?

Plenary Guardianship for aging adult with dementia.Jim was becoming increasingly confused and estranged, and his actions were unpredictable. One day his wife asked him to put the kettle on for a cup of tea; he replied ‘yes’. When his wife came back into the kitchen a short while later, he was just standing there staring at the kettle as if it were a foreign object. It seemed he had lost interest in life, his financial affairs were in disarray, and he could no longer find the words to communicate it. He had forgotten how to drive, read, or perform any normal daily tasks, to the point where he was unable to dress himself in the morning. His aging and unwell wife was finding it impossible to manage his dementia and their estate any longer, and he clearly could not care for himself. Jim’s wife took him to the doctor and her worst fears were realized – the doctor declared him incapable of making decisions for himself. It was time to consider plenary guardianship, as Jim was not competent to enter into a Power of Attorney, the document in which a competent person grants authority to another individual to act on his/her behalf. See Dementia and Guardianship

Plenary guardianship is when the court finds an individual incapable of caring for themselves, and therefore gives a legal guardian rights over and responsibilities towards that individual or “ward”. Plenary guardianship must be appointed by the court. This kind of petition would include the name of the person in need of guardianship, their date of birth and address, and a report by a doctor stating the physical and mental incapability of the person. See What is the Difference between Guardianship and Power of Attorney?

Types of Guardianship

Other less restrictive types of guardianship do exist and the court will decide which is suitable for the individual in question. Illinois law permits several different types of adult guardianship:

Limited Guardianship

A limited guardianship permits the guardian to make some, but not all, decisions for the person under the guardianship.

Guardian of the Person and Guardian of the Estate

There are different types of plenary guardianship – it may be as to the person (personal care, education, and medical services) or as to the estate (financial affairs and property) or as to both.

Temporary Guardianship

In emergencies, the court may appoint a temporary guardian for up to 60 days to protect a person with special needs’ interests.

Successor Guardianship

A successor guardian takes over the guardianship when the initially appointed guardian no longer can serve.

Testamentary Guardianship

Parents of children with special needs use testamentary guardianships to protect their children who are living under guardianships in case of the parent’s death.

Duties of the Plenary Guardian

A Plenary Guardian has legal rights by the court to make all decisions for the person that is found to be incompetent. It is important to note that this is a legal appointment, not a medical appointment. The medical report presented to the court is only part of what a judge will consider in making a decision for a potential ward. Once someone is under guardianship they will not be able to engage in certain activities. This is including, but not limited to, their estate. While someone is under the care of a guardian they may not:

  • Determine residence
  • Consent to medical treatment
  • Make end-of-life decisions
  • Possess a driver’s license
  • Manage, buy, or sell property
  • Own or possess a firearm or weapon
  • Contract or file lawsuits
  • Marry
  • Vote

The plenary guardian is responsible for managing the needs of that person. If proper housing needs to be secured, it is the responsibility of the guardian. If medical needs have to be addressed, it is the responsibility of the guardian. The guardian is also to manage the client’s financial and insurance needs, including applying for Medicare or Medicaid or Social Security if necessary. Some additional things a plenary guardian can be responsible for include the following:

  • Determine and monitor residence
  • Consent to and monitor medical treatment
  • Consent and monitor non-medical services such as education and counseling
  • Consent and release of confidential information
  • Make end-of-life decisions
  • Act as representative payee
  • Maximize independence in least restrictive manner
  • Report to the court about the guardianship status at least annually
  • Marshall and protect assets
  • Obtain appraisals of property
  • Protect property and assets from loss
  • Receive income for the estate
  • Make appropriate disbursements
  • Obtain court approval prior to selling any asset
  • Report to the court or estate status

Plenary Guardian Requirements

It is required by Illinois law that a plenary guardian be 18 years or older without a felony and capable of the responsibility. It also states that you cannot be in service to the ward other than to provide guardianship services and that there may not be any debt owed to you by the ward. These simple requirements come with much responsibility. Often a well-intended family member is willing to take on this role without fully understanding the magnitude of what they are getting into. Knowing all there is to know to help someone in need of a guardian is challenging. The impact of being the caregiver can be tremendous. See Recognizing the Signs of Caregiver Burnout

If you find yourself in this situation, we suggest you sit down with a good estate and probate attorney experienced in these matters to learn what is involved before you decide to take it on. If you have already accepted an appointment then your attorney might be able to help you manage and understand the requirements.

As advocates and professional guardians we can help you put a plan in place that is easy to follow and maintain. You don’t have be in this alone. With professional expertise you will have the support you need to be the best guardian for your loved one and know you are making the right decisions.

If you have any questions regarding guardianship, please post them below so we can raise awareness and help others who might be facing similar issues.