OA MONTH CAREGIVING WEBINAR 


Hello everyone and welcome to the consumer financial protection Bureau Older Americans Month webinar on financial caregiving. Today we are pleased to be joined by two experts from the Center for financial security. To discuss financial caregiving issues. As you may know, this year's theme for Older Americans Month is communities of strength. That is a theme that takes on new meaning during the pandemic. So, today we are going to discuss caregiving trends, then highlight some tools and resources to help financial caregivers during the pandemic and the on. In the spirit of Older Americans Month, we hope the information we share will help you to make your communities stronger. Let me begin by introducing today's speakers. My name is Lisa Schifferle,  and I'm a senior policy analyst in the office for older Americans at the consumer financial protection Bureau. Today and fortunate to be joined by two experts from the Center for financial security. Dr. Mary Hamman,  and Dr. Yulya Truskinovsky.  Dr. Hammond is an associate perfecter of economics and also associate director of the retirement and disability research center at the University of Wisconsin Madison Center for financial security. Dr. Hamman's  current research is understanding trends. She holds a PhD from Michigan State University and we are really happy to have her here with us today. Dr. Yulya Truskinovsky  is a health economist who Scotty's long-term care and aging. She holds a doctorate in public policy from Duke university and is currently an assistant professor of economics at Wayne State University. Dr. Truskinovsky's  current research focuses on the economics of informal care and the impact of social insurance programs on how individuals and families make decisions about work and family caregiving. We are also very happy to have her here today and we look forward to both of them sharing their time and expertise on the webinar. And look forward to their presentations. Here is what we are going to cover. Professor Hamman will open the webinar,  and then professor Truskinovsky  will discuss how COVID-19 has changed caregiving. Finally, I will offer some CFPB resources to support family caregivers  during the pandemic and beyond. At the end, we will take your questions. As you listen to the presentations, these do feel free to start putting questions in the chat. Lease address them to all panelists, and after our presentations, I'll post some of your questions to the panelists so you can get them answered. Now, I will turn it over to Dr. Hamman.  

>> Lisa, thank you so much for that introduction. So, as Lisa mentioned, I am currently working on a research agenda where I'm studying some of the trends and patterns in the living arrangements of older adults. I like to share with you some of those results, looking back really over about four decades. While what I share with you today does not encompass what has currently happened during the COVID-19 pandemic, I know my colleague Yulya will be able to provide some insight there,  and I'd be happy to answer some questions as we move to the discussion portion. Before I begin to present some of my resource, I wish to greatly acknowledge support from the Social Security Administration, and also just to note that all of the opinions presented today, or any errors or omissions are my own, they do not represent the views of SSA or any agency of the federal government. 

 So, I'd like to first begin with a bit of a pillow. Despite the fact our population is aging there actually fewer aging adults living in nursing homes. If you know the date on this site is 1999. This is not to takeover thing or something that has happened quite recently, this is quite a long-term trend. It is some of that trend that I would like to highlight and dig a bit deeper into with you today. First I want to share with you the interestingly this trend is concentrated on the lowest income older adults. I'm going to take just a moment to break down this graph and we will be looking at several versions of this graph as I explained some of the other trends I found in my research. So, what I'm presenting here is the percentage of people who live in an institutional setting, you can think of this as a nursing home, by age. So, each dot represents an individual's age, and as you read off the Y axis, that is a percentage that lives in a nursing home.  I have two panels. On the left-hand side, this is a group that is likely not eligible for SSI. If you're not familiar with what SSI is, please bear with me and I'll go into detail soon. You can think about that as a group that is not likely to qualify for Medicaid, who has some more financial resources, but are not necessarily wealthy. Whereas the group that is on the right-hand side tends to be very low income and low access older adults. These are people who would qualify most likely for Medicaid, and also for this SSI program. Now, what's interesting here is if we look at the change over time, so, looking at the squares, the hollow squares, that represents the percentage of people who lived in a nursing home as of 1980. The red dot is that same percentage as of 2018. Now, on the left-hand side, people who are more financially well-off, there is very little change. The entire decline in nursing home residents appears to be coming from this very low income population. It's a large decline. Look at the very oldest, those who are nearly 90 years old. In 1980, about 40% of those individuals lived in a nursing home. Whereas if we look at those people who are nearly 90 years old as of the most recent data in my work, there is only about 20% who reside in a nursing home. So, if nursing home residents are falling, where are people living instead? This is part of what I tried to answer in this particular project one natural response would be that they are residing with others. I don't mean with a spouse or a partner. I mean with other family members, perhaps with adult children, or it could be grandchildren, or it could be unrelated individuals as well. The way that I conceptualize this is quite broad. Now I'm showing you the same graphs for the same two groups, lower income adults are on the right-hand side. Again, the squares are 1980 and the.org 2018. We can see that co-residents has increased especially among the most financially vulnerable households, but not in a pattern that seems related to what we saw for nursing home residents. Remember most of that decline was concentrated among the very oldest old, where as co-residents has really expanded at all ages and perhaps more so at the younger end of the old age spectrum. Those who are in their 65 to 70's. There's also a bit of a difference here. It looks like there has been a decline in the rates of co-residency for the oversold who are more financially well-off. While there are interesting trends here, it's not entirely clear that this is related to the decline in nursing home residency. In case you're not convinced, let me break this down to take it further. I've added some dots here to show you what was happening in the intervening decades. The latest of the gray dots is 1990, movie up to the darkest of the great Mac dots is 2010. What we can see here is a lot of the increase that was apparent by 2018 really happened between 2000 and 2010. So, if you're thinking great recession, that's what I'm thinking as well. I think that there is evidence that there was a lot of doubling up for economic reasons around that time, and perhaps some of those living arrangements have persisted going forward. 

 What about living in one's own home? What we might consider to be aging in place, but without co-residence?  There are some interesting trends here as well. Again, they are slightly different among our lowest income households and those with more financial resources. So, if you look at the panel on the right, this is again the lowest income older adults. We can see that although those who are age 65 to about 80, are now currently less likely to live in their own home without Susan Funk  those who are over about age 80 are more likely currently than what they were in 1982 live in their own home without co-residence.  That change is actually fairly large. So, among the oldest old, it's about a 20 percentage point change. It is approaching the size of that decline in nursing home residency that I showed you initially. The trend is similar among the oldest old for person to have more financial resources, but the change is smaller, so the difference between the red dots on the squares reflects less change over time for our older adults who have more financial means. 

 You might have been wondering about assisted living, and I was too. I think that there have been really dramatic changes in this industry over the study period the last four decades. What is quite interesting, at least in the data I am able to use here, and all of this comes from the census and data from the American communities data. It is quite hard to measure and pick up the shares of people who live in assisted living arrangements. One of these limitations to the work that I do, and to really our understanding of long-term care as a whole, is a lack of good data about assisted living. With that caveat aside, you can see what you might expect to see. Assisted living has become more prevalent since 1980, but perhaps you may not of expected that the most dramatic increases among the lowest income older adults. Now, please do be aware, look at my Y axis,  there is a bit of a change. We are only talking about a five percentage point change from the squares to the dots on that right-hand panel at its largest. So, this trend is small relative to what I just showed you about older adults aging in place without co-residence.  Nonetheless, I think the assisted living trend is an important piece of the story. So, we are going to dig a bit further into this. 
 So, it might be surprising that I find the biggest increase in assisted living is coming from those with the least financial means. Because as we know, assisted living is quite expensive, right? It is, and it helps to put it in perspective and talk a bit about some of these costs. Just like anything in healthcare, there is the full price, but then we also need to think about what resources we have in terms of insurance, and public programs that might help to cover those costs. So, as many of you may be familiar with, nursing home care is extremely expensive. What I'm showing you here is the annual cost of nursing home care according to the 2020 cost of care survey. It's over $100,000. Home health care and assisted living, according to the survey at least, are fairly similar in cost, but what I'm comparing it's full-time home healthcare, not part-time. What families use when it comes to home healthcare Mayberry quite a lot in terms of the frequency and intensity of their use. Assisted living is still quite expensive, about $50,000 a year. So, that's about five times the average cost of childcare, and it is more than one year of commission at some of the most elite private schools in the country. These are but financial burdens for family this is why, although families may not have had any experience with Medicaid or other low income support programs previously, shortly after older adults enter into nursing home care for example, it is common for them to become allocated eligible because they exhaust their own federal resources quickly to what is a little bit challenging is how people can pay for home healthcare or assisted living or adult day care. All of these would be considered community-based care. The extent to which you can use some public programs like Medicaid to pay for that type of care really depends on where you live. Medicaid is a state program. In some states, there is support for care in these settings. In all states, there is support for care among those who qualify in a nursing home setting. Let me show you what that means if I come back to these trends in assisted living and illustrate why I think this policy is important. The policy environment in one's state is important. Here is the increase in assisted living I showed you earlier going from 1980 up to 2018. Here again I'm going to zoom in just on the lowest income adults where we have the larger gains. I'm going to add in those additional decades in between. You can see that the series really separate and we see the prevalence of assisted living grow among the oldest old after 1990. What happened in the intervening period is there was a Supreme Court decision in 1997 that indicated adults should be able to use their public benefits to pay for care in the least restrictive setting. At this point, we started to change the way in which many state Medicaid programs covered care, many of the waiver programs came into play at this time. Again, the rollout was not instantaneous, and it is not even across states. Even still, there are big differences in what you can pay for with some of these programs, depending on where you live. And, there have been subsequent programs that have tried to rebalance or provide more access to home and community-based care, including legislation that was part of the affordable care act. 
 So, I mentioned to you that I would clarify just a little bit about supplemental security income as well. I have mentioned Medicaid quite a bit. It may be more familiar to you. It is what many older adults rely on to pay for nursing home care. It is a tested program meaning there are income and asset limits. Also, for Medicaid to cover either nursing home care or in most states, community-based care as well, we need to have an institutional level of care need. That means that there is some sort of health determination. Broadly speaking across most programs that is required. That differs a bit from the supplemental security income program. SSI is different from your old age insurance benefits. It is not the same as what most people think of as Social Security. This is a means tested program that is available for persons over age 65 without any disability determination. Younger people can receive SSI as well, but that requires a disability determination. The income and asset limits that apply for SSI are actually quite similar, and in many states identical, to what applies for Medicaid. In some states, there are supplemental payments that help older adults pay for room and board or other necessary daily living expenses. So, supplemental security income is income support that goes to the older adult. It can be used to pay for resources while they are living in their own homes, but benefits are reduced if they move into a nursing home because in that eventuality, the assumption is they are arm allocated eligible. Medicaid would cover room and board. It's also important to note, we talked about co-residence earlier,  that SSI benefits are reduced in situations where an older adult moves in with for example a family member, like an adult child. Unless the older adult is contributing to room and board expenses. So, some of those financial discussions that you have about caregiving and planning really will need to get into the very detailed discussions of who will pay for what. If you expect to be financially a caregiver for a person who may qualify for some of these programs. Now, before I close out and hand the ball over to my colleague Yulya  to talk a bit more about family caregivers, I want to share disagree personal anecdotes. The picture from my first light is actually my grandfather. This is him when he was about 84. He is sitting on the front porch on his farm in Michigan. He is talking to my son. I'm sharing this with you because my family, like many, had trouble having these sorts of discussions with them. We avoided some of the tougher questions, probably longer than we should have. That meant that he and my grandmother were relying on informal care from family, and living in their home probably past the point when it was optimal for them to be doing so. They were quite low income, but high asset as farmers. It's especially those sorts of situations that you want to be cognizant of as a financial caregiver. These aren't comfortable discussions, but it's a whole lot less comfortable to live with the results of not having those discussions. So, I hope that our talk today in sharing some of this research is helpful to you as you navigate these challenges in your own lives. Yulya, I'll go ahead and pass it over to you now.  

>> All right, thank you very much Mary. Thank you to Lisa and be CFPB for the opportunity to be here today.  And to share some of my own work here. So, I study family caregiving almost exclusively. Like Mary, and probably like most of you here, I also come to this topic with quite a bit of personal experience. So, here I have some pictures of my grandparents taken at different points in time. So, I'm in some of these here because my grandparents took care of me a great deal when I was a kid, so that both of my parents could work full-time. Then, they subsequently needed a great deal of care themselves as they got older. Despite the fact that they had formal caregivers, which they accessed through the Medicaid program, my mother took on a great deal of the care work. For a period of about 10 years until they passed away, juggled a full-time job and almost daily care for both of them. That motivates a lot of the questions that I have about how families really navigate these decisions around family caregiving. So, I have a very similar disclaimer. Identical disclaimer to Mary in fact. I gratefully acknowledge financial support from the SSA, and they are not responsible for anything that I say today. So, I'll start just by highlighting something that we all know. Caregiving goes far beyond the parent/child relationship across, and really stretches across the life course as a fundamental part of all of our lives. We all likely either are ourselves, or know somebody who is providing a loved one with regular care. 53 million Americans are supporting a parent, a disabled child, or a spouse that has a chronic illness or disability. This is according to a 2020 study by AARP. One in three grandparents regularly care for grandchildren. That caregiving goes both up and down in terms of generations. I wanted to highlight kind of three features of family caregiving that I think are particularly important. 

 First, is that family caregiving, in particular to adults, has become increasingly complex. So, about 6 in 10 family caregivers who are providing care for an elderly family member, are regularly performing some kind of medical or nursing task. This is again according to the AARP. What this means is as kind of Mary showed us, this trend away from institutional care, and towards in-home care, right? A lot of those caregiving roles that can be a little bit more difficult, and a little bit more medically involved, are actually happening in the home and being carried out by family members who may not have a great deal of medical training. 

 The second trend is that the majority of caregivers also work. We focus on this tension between caregiving and work a lot when we are think about parents of young children, but this is also true for caregivers of the elderly. So, we know that over half of family caregivers also work. Not only do they work, but they are breadwinners in a sense that they are responsible for a substantial part of a family's income. 

 Finally, democratic trends and policy changes are suggesting that this need for family care, and the demand for family care, is only going to increase. So, we know that the U.S. population is aging, and we also know that there has been a shift in both kind of a community perspective, and also a policy perspective for more people to get care at home. To age in place, age in the community, and kind of have that long-term care provided to them, rather than be in an institution such as a nursing home. 

 Okay, so, let's look at some trends over time. So, Mary showed us some trends in informal institutional care. She mentioned that there are less adults living in nursing homes. So, in this graph I'm going to show some trends over a shorter time period. here, we are focusing just on community dwelling adults who may qualify for a nursing home. So, these are adults who experienced two or more limitations with activities of daily living. So, these are people that could be potentially in a nursing home, but are aging at home in the community. I want to highlight two things here. So, first, the share of these adults who have high care needs, but who get no care, and that is this orange, the top of the orange bar, has fallen since 2004. Overall, that's a very good thing. There is less unmet need. More people who have care needs are having those needs filled. The second thing I want to highlight, is that the space, this increase in care, is filled by those who are getting either both formal and informal care, that that kind of bluish purple set of bars. Or, only informal care. That's that kind of goldish color. We see an increase either in both formal and informal care, or only in informal care. So, none of this care is being provided by formal care only. In fact, very few of these high needs older adults are getting only formal care. When they are at home. So, family care is growing. Even in cases where formal care is available, or people are getting formal care, family care is a supplement rather than a substitute for that care. When people are aging in place, families are always going to be involved, no matter what. 
 So, given that we expect this large increase in the need for family care, and in families providing care, I spend a lot of time thinking about what is the impact of this family caregiving on employment? That is really the focus of my research agenda. I'm really only going to be able to give you a very kind of quick summary of what I've been finding recently. So, just a short snapshot, but as I mentioned, many caregivers are also breadwinners. They are employed and they contribute substantially to their household income. In fact, about 73% of caregivers are employed in the year before they start caregiving. Okay? Once they start caregiving, their likelihood of work falls by between 3% and 5% in the first two years. So, the average caregiving spell lasts about 3 to 5 years. We see kind of an immediate and some sustained decrease in employment over the first two years. Many caregivers to leave work never return. This is true even for those younger caregivers who may not qualify for retirement at the time when they leave work in order to provide care. This early kind of pullback from the labor market, this nonparticipation, can have significant implications for the long-term retirement security of those caregivers who are themselves, most commonly adult children of the elderly, or nearing retirement themselves. And who may have caregiving needs in the future. So, finally, I've found that many future caregivers reduce their employment, even before caregiving starts. What this means is that the anticipation of future caregiving needs is going to change the way that people make decisions about work, even before they started caregiving. So, even thinking that your mom may need help in the future, is going to impact may be the kind of job opportunities you pursue. Whether you accept a promotion. Whether you choose to move to a different city or a different state in order to pursue an opportunity. So, family caregiving, even the anticipation of family caregiving, can have a substantial income on the financial well-being of the caregivers. 

 Finally, while it is not a focus of my research, I want to highlight that along with these research highlights on financial health, caregiving can also have impacts on the physical and mental health of caregivers. So, there has been a lot of really important work that has shown impacts on financial and mental health. Okay, so now I'm going to switch gears a little bit. Pivot to talk about what has been very present for all of us over the last year plus, COVID 19. Okay? 

 So, in my kind of reading of what has been going on, and the discussing in research and in policy, there has been a lot of evidence on how COVID-19 has disrupted formal care settings. Whether that be nursing homes, but also childcare centers and other formal care arrangements. There has been significantly less focus, from my perspective, on care provided in the home, on family caregiving arrangements. The family caregiving is important for a number of reasons. Not least of which is that the majority of the elderly do get their care at home as we discussed. The majority of elderly are not in nursing homes, they are at home being cared for by a combination of formal and family caregivers. Okay? This context, especially at the height, kind of during the first wave of the pandemic, and at the height of COVID-19, was just as -- Was also susceptible to high risk of COVID-19 transmission. National data is somewhat scarce on this question of what was happening to family caregiving arrangements? I was lucky enough to have the opportunity to participate in a study last year that was led by some colleagues of mine at the University of Michigan. Which is called the COVID-19 coping study. The objective of this study was to look at the impact of the early COVID-19 pandemic on the well-being of older Americans. Their experiences, their subjective and mental health. How they were coping. Changes in employment and other factors. 

 So, I'll tell you a little bit about the sample in this study, and then I will show you some key results. So, the study included respondents who were at least 55 years old. Currently living in the U.S. It was administered in two languages, these are English or Spanish speakers. Respondents were recruited between April and May of 2020. By a professional survey company. So, you can think of this as a national sample, a snapshot, of Americans 55 and older living in all 50 states. During the very first kind of early first wave of the COVID-19 pandemic. 

 The respondents in this study participated in a 20 minute online questionnaire. They were asked a whole bunch of questions. We collected some information about demographics, employment, about whether or not they had COVID. Their own physical mental health. What were they doing in response to COVID? How were they changing their behaviors? We had a module on family caregiving. So, we asked people if they were providing care to a family member before the start of the pandemic, and how their caregiving behavior had changed as a result of the pandemic. To my knowledge, this is the kind of the only data that we have available about how these caregiving arrangements changed in the first wave of the pandemic. 

 Okay, so what did we learn? First, we found that over half of respondents who identified as family caregivers before the start of the pandemic reported that their caregiving was disrupted in some way. So, about 30% said that they found themselves, as a result of the pandemic, providing more care, or taking on new caregiving roles. About 20% said that they were providing less care, or were unable to provide any care at all. They were unable to carry out those roles. Among those caregivers, who were providing more care, all right, so they were taking on new roles, or expanding the time that they were caregiving, those caregivers tended to be younger. Still within that 55 and older group, were more likely to be female. Or, more likely to be black or Hispanic, and were also more likely to be employed prior to the pandemic. So, what we find is that that additional extra caregiving responsibility is being shouldered by the same people who we know are also experiencing, or bearing the brunt of the pandemic in other ways. As well. 

 Okay, so, given that we found this very large percentage of families who were experiencing caregiving disruptions, we wanted to know what impact these disruptions were having on caregivers. Or, if there were correlations between caregiving disruptions in the well-being of caregivers. Now, we don't know anything of course about the care recipients, but we did ask caregivers about kind of their self-reported mental health. So, we have depression symptoms, anxiety symptoms, symptoms of loneliness and well-being. We wanted to look at the relationship between those outcomes and caregiving disruptions. Okay, so this is kind of a complicated graph, but I'm going to talk to it slowly. 

 So, we split the sample into four groups. A reference category is going to be non-caregivers. So, people who were not providing any care prior to the pandemic. We then compared those two to people who were caregivers, but who experienced no disruptions. So, this first top sets of bars here is kind of gray, blue greenish bars. Is for that 50%, just under 50% of caregivers who experienced no disruptions I'm charting the difference in their mental health outcomes. Their rates of depression, anxiety, and loneliness, and self-reported health. Are no different than people who were not caregivers. So, they look very similar to non-caregivers. However, those next two groups, okay, we are looking at those caregivers who experienced disruption. Either by having to provide more care, or being unable to provide care. So, we see that among those two groups who experienced disruptions, we see much higher -- We see that those caregivers who experienced disruption are much more likely to experience elevated negative mental health outcomes, such as higher depression, higher anxiety, and higher loneliness than non-caregivers. So, there is clearly some important relationship between caregiving disruptions in particular, and increased symptoms of stress and anxiety and depression that have sort of -- That are brought out by COVID-19 variant overall, I think COVID-19, the experience of the last year, has brought really into focus what we all know to be true. Which is that caregiving arrangements, many of which are often cobbled together between some formal, some family care, can be extremely fragile. Disruptions, when they arise, and they arise quite often, can be very hard to deal with if you're unprepared, and can have big impact on caregivers. Both through their impacts on their economic well-being, employment, but also mental health and their ability to cope with their responsibilities. I just wanted to end with this headline that I saw in the New York Times just last week. COVID forces families to rethink nursing home care. Which highlights that COVID-19 may have actually accelerated this trend that Mary highlighted for us early on of families moving away from nursing homes and towards home care, which is going to inevitably involve more family caregivers. So, thank you, thank you very much. I will pass it on to Lisa. 

>> Thank you so much for those really interesting presentations. I'm looking forward to getting to the questions from the audience soon so that we can learn more from your presentations. First, I want to tell you a little bit about the CFPB resources for financial caregivers  now that you have heard about some of the caregiving trends. Again, my name is Lisa Schifferle and I'm a senior policy analyst  in the CFPB's  office for older Americans. I'm going to tell you a little bit about the CFPB's managing money guides which are great resources to support financial caregivers.  As you heard from Mary with the story about her grandfather, sometimes it can be hard to have this conversation with Klebold about planning for caregiving needs. So, these guys are here to help you with that. Just like the other speakers, I also have to give a disclaimer, which is that anything I say is my opinion, and does not necessarily reflect the opinion of the CFPB.  

 Let me begin by telling you just a little bit about the CFPB is  office for older Americans. Our office engages in research policy and educational initiatives to help protect older consumers from financial harm. We also create tools and resources to help older consumers make sound financial decisions as they age. We have a lot of resources you can use or view online. And order in bulk for free. You can find those all at our website. 

 Right now I want to start by highlighting a brand-new resource that was just released this week. This is part of our managing someone else's money guide and it is called considering a financial caregiver. This new piece is really designed for people early in the caregiving process, maybe you are just starting to notice that a loved one may need help with managing their finances. Or, maybe you are planning ahead for your own financial future. So, this piece helps you know your options so that you'll be able to choose what works best for your situation. Basically the new publication covers informal caregiving options like convenience accounts or adding a trusted contact person to your account. It also covers informal caregiving options like power of attorney, guardian, or government fiduciary. Finally, a list of questions to help you consider who is the best person to choose as your financial caregiver. You can find this at the website. We hope you'll check it out in order to get copies and share them in your community. I'm going to tell you a little more in depth about what you will find in this piece. As I said, it covers three different kinds of informal caregivers. So, if you're just starting out in financial caregiving, and informal caregiver might be the right choice. It is basically someone who helps on an as-needed basis. These are the three different types of informal caregivers we discussed. 

 The first is a conversation partner. This is basically just when you get a trusted relative, friend, or professional an overview of your finances, you can share as much as little as you want and you are not giving up any control. My mother actually recently did this with me and I found it very helpful. She is still able to manage everything herself, but if God forbid something happened, and she not able to, I then know where all her accounts are and what they are in case I do need to step in. So, this conversation partner is just starting that conversation with a loved one. It can be as simple as asking that person to come with you when you visit your banker or financial adviser, or just giving them information about what accounts you have so they know how to step in if needed. 

 Another informal caregiving option is what's called a trusted contact person. If you name a trusted contract person on your brokerage account that allows the financial institution to contact the trusted person in certain circumstances only, like if they think you are being scammed. So, trusted contacts are something that is available on all brokerage or investment accounts, and you may also be able to get them from other bank and financial institutions or credit unions. So, just ask them about being a trusted contact or emergency contract on your account. It's important to know that these trusted contact do not have access to money, they just get notified of the financial institution sees signs of financial exploitation. For example, if somebody is wiring a large sum of money to what appears to the financial institution to be a scammer. 

 Another informal option we talked about is a convenience account. This is when you name someone to help you deposit or withdraw money and write checks. It's not the same of a joint account which people often think of when they are managing someone else's money. The convenience account does not change ownership in the money in the account, or give your helper the right to the money when you die. The money belongs only to you, so it can be a really good option. Sometimes people think of joint accounts for managing money, but this can have unintended consequences. For example, see if my mother put me on a joint account so I could help manage her money, if you were to pass away, the money would all go to me in a joint account, but you might have wanted it to go to my brother too. Also if I got in debt, they could come after her money. Where as a convenience account does not have those issues. So, it's a good thing to consider in terms of informal caregiving. 

 Now, the guide also talks about formal caregivers. Power of attorney, guardian or conservator, trustee, and government fiduciary. These are all types of relationships that we have actually in depth guide about that I'll talk to you about in a minute. The choosing a financial caregiver document lays out all the options for you to give you a real quick overview. It also gives you tips on choosing a financial caregiver, and questions you can ask like do I trust this person? Do I feel comfortable sharing my wishes with them? This is someone who is going to listen to and honor my wishes. Are they willing and able to take on the responsibility? A good time to think about the tough issues like drug abuse or alcohol abuse, bankruptcy, or mental health challenges that may make a family member not necessarily the best person to be your financial caregiver. Think about whether it is someone who can manage the money and property in your best interest and keep good records. Now, you can find all the questions and a lot more in that whole new guide. It's on the website. You will also find these index guides for formal financial caregivers. These guides help financial caregivers understand their duties and help them -- They have information on identifying Bennett's a care recipient can be eligible for. They provide tips and resources. They also describe warning signs of financial exploitation. They cover four different types of formal caregivers. The first one is a power of attorney. This is the most common one. This is when in a legal document someone knows as the principal give someone else legal authority to make decisions about their money if they are no longer to do so. In some states it is called a durable power of attorney. Really, the important thing to know, a lot of people say why should I get a power of attorney? They give you control to name who you want to manage her finances, and also make it easier for your loved ones if you do become unable to manage her finances. You'll hear a little bit about why when you hear about guardianship in a minute. Basically you retain control until you no longer are able. So, the power of attorney is really the number one financial planning document to think about. When you are getting into the formal caregiving. 

 We also have a guide for government fiduciary's. If your loved one gets government benefits from Social Security or the Veterans Administration, then they may need what is called a representative payee or be a fiduciary. That person manages only the government benefits. The authority does not extend to any of the benefits. So, if you're a government fiduciary, you can manage that person's benefits, but you don't have authority over everything else. You need to get an additional authority like power of attorney in order to have that. So, this is a good guide to actually bring with you and give to people because often times people don't fully understand the role of government fiduciary's. 

 There is also a guy that we have about guardianship. This is when the court steps in to name someone to manage money or property. So, if you don't have a power of attorney and say you get into a car accident or have a stroke, then your family may need to go to court and get guardianship. This can be a longer, more costly and cumbersome process than power of attorney. It can be very helpful, but it also gives you an idea of why you may want to think about getting a power of attorney when doing financial planning. 

 If you are a guardian, this is a great guide to help you through the process. The last guide we have is a guide for trustees. We are talking about revocable living trusts in this guide. The revocable living trust is a legal document and basically it sets aside some of your assets like you could just put your car in a trust. Or, you could put $40,000 in the trust. That money in the trust goes to the person who you name if you become sick or injured or unable to manage her finances. It also passes on to that person after you pass away. So, the trust is another formal type of financial caregiving relationship you may want to look into and consider. The guide gives you a lot more information about that. So, those guides are all on managing someone else's money guides, which again are available at the website on your screen. I also want to let you know about our pandemic related resources that the website seen here. Here we have resources in a variety of different languages. On a bunch of different topics. They can help you financially protect yourself during the pandemic. It includes credit and debt management, student loan repayment, what to do behind on mortgage and rent, skin protection and a lot more. It also has some great short videos and it's really the best place to check back for up-to-date information. 

 Not, this next slide has all of our contact information. For the office for older Americans. We really do want to be a resource for you. Please check out all of our materials at the website. You can order any of them for free. The consumer finance website is there. Once again, in celebration of Older Americans Month, we do hope that you will take the materials and everything you learned today and make your community stronger. So, now I am going to turn to your questions. I see a lot of them have are to come in, but feel free to add more. 

 One question I see here is has anyone seen an increase in elder financial abuse during COVID-19? I can start by saying that I know that there has been an increase in scams against older adults and against really all age groups during the pandemic if you look at the FTC's consumer sensible data you will see a significant increase during the pandemic. I don't know if other speakers want to add anything to that question about whether scams and fraud have increased during the pandemic. 

>> I haven't seen anything specific. Again, I would imagine yes. The trick with that question is with a lot of the family caregiving questions is data collection. Where is the evidence? Where can we see the evidence of that fraud taking place? 

 >>Okay. Thank you. Here is a really interesting question. Someone is asking whether there have been comparison studies between longevity and health when aging at home as opposed to nursing homes or assisted living. I think that is something we all wonder about when considering our loved ones, and even our own future. Are either of you aware of any studies that talk about that? 

>> So, I will give what is perhaps a slightly frustrating answer to that one. It is a little bit difficult to answer that question well because often times we think about the long-term care continuum. Nursing homes tend to serve people with the most acute long-term care needs. So, then if we start to think about health incomes, is it that there is something about the nursing home that isn't working well, or is it that people who are more sick, or have more complicated activity daily living, or mental activity with daily living needs end up in that setting? What I will say though is some of the quality metrics that are available, it does seem like for those people who have low care needs, perhaps there is better quality of care provided in a community-based setting. But, measuring quality outcomes in community-based setting is a very open area of research right now. So, I don't know if Yulya wants to say more there.  I know it is frustrating to be that circumspect about it, but that's honestly what we know about it at this point. 
 
>>Thank you. 

>> I would definitely echo what Mary says. I think my kind of reading of what again is a very nation but sort of expanding area of research is that so far it appears that I think on average for people kind of with a lower level of needs, they do just as well at home. As they might in a more kind of structured setting. At much lower cost. While for higher needs adults, I think that is much, much trickier question. It is much less clear if there are benefits and back to being at home, in particular higher needs adults. Like again, as I mentioned, if you have very complex tasks that need to be carried out by a number of caregivers. Again, it depends on what kind of resources people have at home. If you can kind of replicate a 24 hour nursing home setting in the home, perhaps if somebody will do just as well. If you are relying on kind of a mixed mash of your neighbor and your two daughters, both of whom worked full-time, that becomes a lot trickier. I want to highlight also that when folks are at home, that kind of, that impact is on -- In all context, the impact is on many family members, but family members end up taking a lot of care tasks on. 

>> Thanks. I think that segues nicely to another question that someone has. I'm assuming this refers to one of the slides in Dr. Hamman's presentation.  Someone is asking whether the home healthcare cost is based on 24/7 care provided by agencies versus non-agencies. 

>> Yeah, thank you. The statistic that I'm using there is from the cost of care survey. I use their sort of standard comparisons. One that I will say is if you are curious about digging deeper into those statistics, they do have a really user-friendly portal to alter your assumptions. The statistics that I provided for you was that $54,912 for home health aide services. That was based on 54 hours per week for 52 weeks a year. So, it is not 24/7 care. That leaves the same kind of gap that Yulya was just referring to.  Picture a family caregiver who has a need for daytime work while that individual is working. If you are trying for someone with Alzheimer's disease. Anyone without expense, you know that the nights are where it gets really hard. We are not necessarily comparing apples to apples when we talk about the nursing home care versus the home health aide, or even the assisted living statistics that I provided. 

>> Thank you, that's a helpful explanation. There is another very interesting question. Someone is asking what would you recommend for someone who has low income, but assets that put them over the limits? I assume the limits for eligibility for certain government programs? 

>> Yeah. So, my best recommendation would be to consult a financial planner for Medicaid specific planner. Because the rules for, for example spend down vary from state to state. Whether or not you can qualify on the basis of being medically needy. Perhaps you have income above what would otherwise be considered the threshold for Medicaid availability. If your state has a medically needy program he may actually qualify. When it comes to assets, the one thing I will say is to be aware that if you give something away, or if you try to send down assets at less than their fair market value, that then has to be considered in the determination. Unfortunately I can't give you one simple answer there and say it works this way in all states for all people, all situations. This is a situation where I think it would be very smart, especially if you're thinking about someone like my grandfather with a farm, or family business. High assets. It might be a good thing to consult a professional about. 

>> Thank you. I see there is a question about reverse mortgages, which we don't necessarily have statistics on, but we do have resources on. I just wanted to recommend to people that the CFPB has resources on reverse  mortgages at the website. There is also a question here asking whether it is true that in nursing homes that are privately owned, the life expectancy is five years, as opposed if they are owned by other companies it is 3.5 years. Is there a higher life expectancy and privately owned nursing homes to your knowledge? 

>> So, it's hard to compare different kinds of nursing homes because not only is the ownership different, but the types of residents in those nursing homes may be different. I know that DC ownership is something that has been quite recent, I think over the last 20 or so years, there has been kind of a move of venture capitalist money into nursing homes. I think it's kind of a relatively new phenomenon. The types of nursing homes that they buy are going to be kind of different than your average nursing home. I think it's a little early still to kind of really do a clean comparison of whether VC  ownership changes the well-being of residents. 

>> Thank you. I see we are almost out of time, so I do want to close with one final question, which is that if there is one you would like our listeners to take away from your presentation today, what would that be? 
 I think, I hope that what you gathered is a sense of the importance of having these conversations early. While financial conversations may not be terribly comfortably, they are essential when you think about the sort of quality of care that you want your loved one to have in old-age, but also the quality of financial help for yourself if you envision yourself becoming a caregiver. As your loved one ages. 

>> Yeah. I would follow-up to say that caregiving arrangements are fragile. Health is fragile. It's important to be kind of prepared for any number of changes, because a situation which may feel stable at one point in time may kind of quickly deteriorate or change. Whether that is precipitated by a health change, the turnover of formal caregivers, or something like a global pandemic. 

>> Thank you both, and thank you so much for sharing your time and expertise on this webinar. We really appreciate it. I know I learned a lot and I hope everyone else did too. Again, in celebration of Older Americans Month, the theme of communities of strength, we hope that everyone does take what they have learned today and pass it on to make your own community stronger. Thank you, everyone, and have a great day. 

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