The Wiser Financial Advisor Podcast

Get Real. Get Honest. Get Clear.

A Caregiver’s Journey

In this episode, Josh Nelson CFP® and special guest Jeremy Busch CFP® dive into the topic of caregiving. We believe you’re going to find it very interesting and enlightening, not only from a financial standpoint but also from a practical standpoint in how you can best support the ones who need caregiving assistance in your life now or will be in the future. Perhaps even for yourself sooner or later. You’re going to find this is an important and an enlightening topic, one that we’re all going to face at some point in our lives.


Wiser Financial Advisor – A Caregiver’s Journey

Hi everyone, welcome to the Wiser Financial Advisor show with Josh Nelson, where we get real, we get honest and we get clear about the financial world and your money. This is Josh Nelson, founder and CEO of Keystone Financial Services. Let the financial fun begin!

Josh: I’m here with Jeremy Bush today. We are both Certified Financial Planners, which is the gold standard when it comes to the financial industry. Today’s topic we’re calling A Caregiver’s Journey. And although neither Jeremy nor I have been full time caregivers, we have been through a lot of situations, as you can imagine, through thousands of conversations with people over the years, people who have been going through this, and we’ve learned a lot through them and what they’ve shared that they wish that had known before they went into that caregiving situation.

Jeremy: We’re presenting this as a conglomeration of topics that we have gleaned from clients and other people we know.

Josh: There are a lot of great books and resources out there but there’s really no replacement for actually having had the experience.

As we get started, as always, our disclaimer is that what we’re talking about today is just our opinions. As you can imagine, everything is individual when it comes to financial planning topics and especially this one, which is about finances related to caregiving situations. Don’t take our opinions to the bank. Talk with your Certified Financial Planner or medical professional, legal professional, tax professional, whatever applies to the situation you’re in, and do your own due diligence on that.

Jeremy: Our agenda for the day is to give you some tips and techniques for various things as they come up.

Josh: We’re gonna fly through a lot of this but we do have a resource at the end that we’ll be able to send to you if it’s helpful for you. We’ve got a Caregiver’s Guide to send out, something you can use as a framework in your own situation.

First, something to be aware of is the handicap stall. If it’s needed, that’s the only stall in the restroom that person is going to be able to access. So only use the handicap stall if you need it. Otherwise, leave it open. I never thought of that before until it came up, but that’s true.

Next is one that we talk with clients about all the time, which is the 4% rule when you’re retired. In other words, don’t take more than 4% per year out of your portfolio while you’re working and live below your means. Don’t spend it all and ideally save 20% while you’re still working, whether through 401K or other savings that you’re putting aside for the future. A reason for that is that you might end up leaving work early to care for somebody, or it could be to care for yourself down the road. It could be that long term care expenses are needed later on that you’ll need to access some funds to cover.

Jeremy: And “in sickness and in health” takes on a deeper meaning when you become a caregiver. And also practicing mindfulness and self-care. It’s all too easy to let yourself go and put all your focus on that person you’re caring for. Then you start to neglect your own well-being, which is not a good thing.

Josh: it’s like that old metaphor about the oxygen mask—put it on yourself first, then help whoever you’re caring for. If you don’t have that oxygen mask on, you’re not going to be good for anybody else.

So we’ve heard from a lot of people that they can get really drained from being a caregiver. They’re willing to do what’s needed, but it can be draining.

Jeremy: You’re helping someone live with dignity. These are loved ones that you’re typically caring for and it can be a rough time, but helping them get through with the dignity that they’ve lived with their entire life is important.

Josh: Another thing to pay attention to is record-keeping, which is crucial, especially if you’re the point person. Clearly if there’s a caregiver situation, somebody has stepped up, so they’re probably going to doctors’ appointments and such. It’s important to take a lot of notes because you’re not sure when you’re going to need that.

Jeremy: There isn’t one right or wrong way to do this stuff. It’s about finding a way that works for you. But one of the things we often hear from people is the accessibility of those notes. For example, you can take really good notes but then as soon as you need them, can you find them? An app or something of that nature where you can take your notes can be helpful because then you know exactly where it is when you need it, no matter where you are.

Josh: You might use the notes feature on your iPhone or your Android, whatever you’re using as a personal device. You can use Evernote or whatever works to put the notes and details of meetings with doctors and other professionals, of medications and dosages, of conditions and treatments, all in order and organized.

Jeremy: Keep it safe and password protected as well, because this is medical stuff about a loved one. You can also keep words of encouragement there, things that keep you going.

Josh: You can’t do everything at the same time. It can reduce anxiety to have a list that will be there when it’s needed. That way too, if people offer to help, you can consult that list, and there might be things listed that they can take off your plate.

We like to talk about the 90 second rule in our family as something to help with letting stuff go. So you can get frustrated and mad or anxious or whatever, but the longer you hang on to stuff, the tougher things can be. We also need to let things go from an expectation standpoint, for example, if you have in mind what you thought your day was going to look like or what you thought your life was going to look like. You might have thought you’d be travelling in your retirement, but you’re being a caregiver. Maybe you thought you were going to work longer, and then life happens. So it could be we’re resetting our expectations and our definition of what success looks like. It could come down to the day—we get an idea of what our day is going to look like, and then life shows up. That certainly would be the case when you’re taking care of other people. We both have a bunch of kids running around and so that happens every day, right? We don’t know what they’re gonna need.

Jeremy: The idea is to be flexible and adjust on the go. That happens more often than not, and for some people that’s harder if you’re used to a regular schedule. That doesn’t mean you can’t have a schedule, but just be prepared for the fact that every day is not necessarily going to go according to plan.

Josh: The definition of mindfulness is being present. Sometimes anxiety creeps in. They say that when we get anxious about anything, usually we’re afraid about the future, so we can’t really focus on the now. And so a lot of anxiety can build up. But the future to a large extent we can’t control, whether it’s family, health, the stock market, all kinds of stuff. But just doing our best to stay present and be focused on what what’s happening now, what we can control right now, is helpful. Whatever it takes for you to get back into now when something comes along that will stress you out and cause a lot of crazy anxiety in your life. It can help to have a short list of stuff that works for you. Maybe it’s prayer, maybe it’s meditation, maybe it’s just breathing or taking a short walk to reground yourself, but whatever it is, you’ve gotta take care of yourself.

Jeremy: And remember that you are not alone; you don’t have to be alone in this. There are a number of resources out there, including online caring support groups with people who have gone through this and have really great ideas, tips and tricks to get through it. There are organizations such as that offer easy ways to keep family up to date about what’s going on.

Josh: I’ve been part of that with other people. It is super helpful for everyone involved. As a caregiver, that way you don’t have to notify everyone dividually over and over again.

Another area to give attention is planning ahead. For example, if you bring Mom or Dad into the home with you, there will be things to consider to keep them safe, whether making adjustments to the bathroom, maybe installing a lift or a new walk-in tub. In some cases, this can have a financial impact. And if they have long term care insurance, sometimes that will cover part or all of those costs. Or Medicare, if they qualify for those benefits. Hospice care. There may be some assistance for that. So stay up on eligibility. And support groups can share information.

Jeremy: Eventually it reaches a point where you just need more professional care. Knowing who to reach out to and when to ask about that is good to think about. Don’t wait too long to inquire about that and get that help.

Josh: It might not be the need for facility care yet, but it could be somebody who comes in and helps out, even just to clean the house. You can get some help. Don’t try to do it all yourself, because eventually you will wear out and if you wear out, then who’s gonna take care of Mom or Dad or whoever it is.

We get questions all the time about long term care: “What’s gonna happen; how expensive will it be; can we afford that; are we going to run out of money?” And sometimes those questions don’t have good answers.

Jeremy: Which is tough because modern long term care policies are not the same as you could find 10/15/20 years ago. If you think about it, your average cost of a nursing home per day (and it can be a lot more than this) is $255. That works out to about $90,000 a year. And the average length of long term care is about three years. We’ve seen that go longer and shorter than that. But for average length, 90 grand per year for three years.

Josh: The government definition for long term care is either a cognitive impairment like dementia, or needing assistance with Activities of Daily Living (ADL’s), which is more physical care of things that you’re just not able to take care of yourself. Two or more activities of daily living will typically trigger a long term care insurance benefit.

And there are different levels of long term care. There’s home healthcare all the way up to skilled nursing care. Sometimes long term care communities will have a progression. My parents just moved into a continued care community. They’re independent, they’re in a patio home right now in a retirement community. But there are resources if they need help down the road to be able to have home healthcare come in, and not have to move but have some level of facility care.

Jeremy: It’s better to think ahead about how to pay for this than to have to try to scramble after the fact. These are tough conversations and you have to have them with family. Maybe it’s splitting costs with family. Or maybe there’s a good insurance option for you. Going down the Medicaid route is a last resort kind of thing because there are spend-downs associated with that. It’s very expensive until you get there and it’s not necessarily the best level of care. But it’s an option.

Josh: With Medicare, there may be some level of care but it’s for a limited time, typically no more than 90 days. And Medicaid is a whole other thing. We’re not attorneys, but attorneys tell us that there are spend-downs and so forth before Medicaid will kick in and start paying benefits.

Jeremy: And the average cost for home nursing care is about three years at around $5000 per month, depending on how much how many services you actually need.

Josh: And some people pay a lot more than that. It’s going to depend on where you live, what part of the country and what level of services are being provided. When it comes to facilities, there are levels such as private room, shared room, cognitive support, memory care.

Some folks struggle with cognitive decline earlier than you would expect. We’ve seen situations with clients who started in their 60s or 70s. So when it comes to financial planning and estate planning, that’s something to visit with an attorney about. Hopefully these topics get introduced as early as possible. Good questions to ask parents is if they’ve done any estate planning. Do you have a will? Do you have Power of Attorney? If something were to happen to you, where would we go to find those things? Do you have a lockbox at the bank? How are you going to pay for long term care services? Do you already have insurance? Is it something that’s still available, or is it just too expensive? It’s important that somebody in the family knows.

Jeremy: One of the best things I’ve heard was to suggest love letters to give in the future. Just writing down memories, things that they remember about you.

Josh: That’s good for everyone but especially older people to preserve memories.

And then if becoming a caregiver means you need to leave your employment, you might be able to take a leave of absence or your short term disability benefits if you need to be a caregiver. So make sure you understand your employee benefits and their employee benefits. You might have somebody younger that you’re going to be caring for, but if they’re still employed, it could be that they qualify for some kind of a short term disability or long term care. The funding is important, but the emotions are important too. So being organized, just asking the questions, I think that’s key. If we introduce any value into the process, that’s what it is in a lot of cases: just asking the questions and getting people thinking about what they haven’t considered or what they don’t know.

It could be that people take turns, pass the baton and share the caregiving responsibilities. Sometimes it means accepting help for more basic things like cleaning so that you can then do the stuff that only you can do, which is emotionally connect with your loved ones.

Jeremy: There are some resources that we have available. We can send these out. We have them in an electronic PDF as well. So just let us know if you’d be interested in receiving those. They go over a lot of this.

Josh: It could be helpful as an outline that will trigger some things on getting organized and starting to introduce those conversations. As Certified Financial Planners, we’re really the quarterback that’s looking at everything. We’re doing a lot more for clients than just one thing. It’s our job to coordinate all that with you and s much as possible to make the complex simple. As fiduciaries, we look out for your best interests and we also care about you and want to make sure that you’re taking care of yourself and that your family is taken care of.

Jeremy: And of course, anytime you work with Keystone, it’s not just Josh and me sitting behind the scenes. You know, we have a whole team of experienced people who all have that same drive to take care of our clients.

Josh: It’s in the DNA of all of us to care about people and the relationships we get to have. So for those of you that are our clients already, thank you for your continued business. Many of you have been clients for 20 plus years in some cases. Some of you are a bit newer, so welcome. Welcome to the family. We want to continue serving you. And for those of you who aren’t clients yet, certainly continue to stay plugged in to what we’re doing. We try to keep these conversations going throughout the year, so contact information for us is pretty simple. It’s just or and our website is . There you’ll find a lot of other great resources as well as pictures of our team. If you’re new to us, it’s a great way to get to know us a bit before we have that more in-depth conversation.

Jeremy: Josh and I have no problem having those tough conversations. It’s better to have those tough conversations up front.

Josh: And even if you’re not in the situation right now, more than likely you probably know somebody who is. We’re happy to provide these resources to anybody else: friends, family, coworkers. And you know, of course, if somebody is looking for a great financial planner, especially a Certified Financial Planner, we’re happy to visit with anyone. That’s almost 100% of how we grow is just by word of mouth.

Have a wonderful week and God bless.

The opinions voiced on the Wiser Financial Advisor show with host Josh Nelson are for general information only, and are not intended to provide specific advice or recommendations for any individual. To determine what may be appropriate for you, consult your attorney, accountant, financial or tax advisor prior to investing. Investment advisory services offered through Keystone Financial Services, an SEC registered investment advisor.