Doris Inc: A Business Approach to Caring for Your Elderly Parents

When it came to caring for her elderly mother Doris, Shirley Roberts thought she had everything under control.

She would make the drive from Toronto to her mom's house in Cobourg every second Saturday and do whatever needed doing from cutting the grass to shoveling snow and basic household chores. She made sure that the neighbours would look in on her mother every so often and recruited a volunteer named Susan to take her mother to her medical appointments and grocery shopping, while coming over for tea and helping with the gardening.

Roberts thought she had all her bases covered, but then, on one of her Saturday visits, she found unopened mail, a burnt out hallway lightbulb, tea stains on her mother's blouse and expired milk and yogurt in her mother's fridge. Soon it became apparent that her mother had Alzheimer's Disease and Roberts had missed the signs and dropped the ball.

What she calls her "Solo Firefighter Approach" to caregiving, that had allowed her mother to live a semblance of an independent life for a year, wasn't working. She was simply putting out the biggest fires of the week. Her infrequent visits paled in comparison to the level of attention her mom really needed, but what could she do? Roberts had a full-time job running a marketing company in Toronto and a new man in her life, she quickly realized she could not devote the amount of time and energy she wanted to for her mother's care without sacrificing something very significant in her own life.

It was a harrowing dilemma that many adult children with elderly parents face.

"There's a tremendous need for a better approach to caregiving," says Roberts If you talk to the people in the healthcare field, the doctors, the nurses, the lawyers, they will all tell you this is an increasing need because families go into crisis, they don't plan ahead, they don't realize what's coming. We plan for having children, but we don't plan to take care of our parents and none of us are ready to die."

That's why she wrote Doris Inc: A Business Approach to Caring for Your Elderly Parents. It details how Roberts, a marketing executive, and her brother David, a chartered accountant, united their business expertise to manage their mother's care like a corporation.
The System Behind Doris Inc.

Doris Inc. began with clear goals in mind: professional and attentive care delivered in a home environment that met all of Doris's needs, strong advocacy for Doris when care wasn't being delivered in a timely fashion, or didn't serve her best interests or what she would have wanted, and careful management of Doris's finances, so that they could pay for her care for the rest of her life. Both Roberts and her brother agreed that they would pick up the tab if the money ran out.

"Between the two of us, David and I joked that he would make the money and I would spend it," says Roberts. "We just took our parents' money and he invested it more wisely and I kept the records for legal and income tax purposes. We both went to business school. so it was second nature to us to do it in a professional way and plan for the future."

To fulfill these goals Roberts and her brother became the family-care leaders, proactively planning all aspects of their mother's care and well-being; Shirley managed the care on the ground and David invested the money and managed the finances. They assembled three care teams; a health-care team responsible for medical, nutritional and hygiene care, and a caregiver-companion team responsible for Doris' happiness, comfort and helping her to eat.
Roberts and her brother also pitched in as family caregivers with Roberts looking after their mother four hours a week and her brother handling what he could from Vancouver, such as working with the audiologist to repair hearing aids or calling in more often when his sister was away on business to see if anything needed his attention.

The Leadership Responsibilities of Doris Inc.

"If you think about a business, it's all about leadership and operations that have to work together to be successful," says Roberts. "If a company doesn't have good leadership, it doesn't go well and if a company doesn't have good operations, you won't have a successful business. It were those fundamentals that were the backbone of Doris Inc."

They decided that they had to be in charge of their mother's well-being, not just medically, but emotionally, socially, physically and spiritually.

"Rather than be dictated to by the medical profession, which happens often, we said, 'Okay, we know her best, we will take charge,'" she says.

For example, they had to choose what healthcare specialist was the right one to go to, they had to find the right specialist and the right nursing home. If someone on any of the teams wasn't doing a good job, it was their job to fire them and find a replacement. They took charge while each playing an equal role in her care.

"A lot of people think that if they're the sibling living in another province, they don't need to get involved, but that's just not right," says Roberts. "If you've got a computer, you can be just as involved regardless of where you live."

As their mother's needs changed, they would communicate and reach decisions together, so they always spoke with one unified voice on everything from the banks, the hearing aid company and especially the doctors and nurses.

"We had an agreement that if anything cost more than $150, we'd talk about it first and agree together because what you don't want is brothers and sisters bickering about how the money was spent."

When it came to the care team under their direction, it was not about dictating to the doctors and nurses what care needed to happen, rather it was about working with them as a team, discussing the issues and reaching the right decision for their mother.

Hiring the Right People and Creating Accountability

"One of the secrets to keeping accountability among the care team members was what I call a visitor's book," says Roberts. "I used my business skills to assess the values of the people I was hiring. When it came to the care team companions, I didn't want somebody who was just after a job, I wanted somebody who had experience doing volunteer work."

Retired personal support workers willing to work part-time were ideal as caregiver companions because of their experience with advanced diseases and they had more free-time and flexibility. Taking care of Doris also gave meaning to their lives, so Roberts found a win-win situation of people with big hearts who genuinely cared for the elderly. Doris herself was present at every interview so Roberts could gauge her reaction to the candidates.

"When it came to the nursing home staff, I would meet every week with the Licensed Practical Nurse and I would discuss with her my mother's issues and because I had these caregiver companions coming in everyday, if any issues came up, they would call me at home and discuss them with me. They would write in a visitor's book if there were any issues."

The log in the visitor's book created a continuity of care that would keep track of what care was provided and if there were any issues. Then Roberts could look over what care was provided for the whole week and she'd discuss it with the nursing home staff.

"We had open communication with the nursing staff and that's the key," says Roberts.

"A lot of people think they go and order them around, but that's not how you get the best care. When you work as a team, you can bring up issues and resolve issues there. Both my brother and I were advocates for my mother. If an issue wasn't being resolved at the nursing level, my brother would call the administrator and they would discuss it with the needs of the nursing home in mind as well. We were realistic and we got to learn their business."

Making the Money Last

Though Roberts and her brother hired a lot of supplementary care for their mother, from caregiving companions to an audiologist and a massage therapist, it wasn't because their mother was rich. Far from it, her income was actually quite modest, but through sound investment and other available financial resources, they were able to make the money last the rest of her life.

"It's about assessing income and expenses and being able to project that over time," says Roberts. "You have to make some decisions as to how long you think your loved one will live and that will depend on what type of disease they have and how old they are, so doctors can help define that. What we do know, and it's listed in the book, what the rough costs are of elder care, but most people have no idea what these things will cost."

With Doris's moderate financial resources, Roberts and her brother developed a strategy that included spending cautiously, trying to grow the income through investments and taking advantage of any tax deductions or credits available. However, even those on a low income can make it work through subsidized and government support, community-based volunteers and increased family support.

Under their moderate plan, Doris had capital assets totaling $400,000 and an annual income of $39,500 -- half from pensions and annuities and half from investments. In the book, Roberts outlines two spending scenarios: $200,000 in assets with low income and spending and $400,000 in capital assets, plus medium income and spending.

Scenario A - $200,000 in assets with modest income and spending

• A small, private apartment in a retirement residence for three years.
• A small, private assisted-living apartment for two years.
• A shared room at a nursing home for three years.
• Two hours a day of caregiving companion support for three years in the nursing home.
• Need at least 4% return on capital assets
• An average pension income of $12,300.
• Run out of money in year nine.
• Family and volunteers would provide additional care support.

Scenario B - $400,000 in assets with higher income and spending

• A larger, private apartment in a retirement residence for three years.
• A larger, private apartment in assisted-living for three years.
• A private room in a nursing home for four years.
• Two hours a day of caregiving companion support in assisted living.
• Four hours a day of caregiving companion support in a nursing home.
• Need at least 4% return on capital assets.
• An additional annual income of $8,000 on top of the $12,300 in government pensions.
• Run out of money in year ten.

Doris Inc.'s financial plan was executed well enough to allow increased spending as Doris's health declined because her kids were reasonably confident she would not outlive her assets, which allowed for excellent care for her and Roberts and her brother could still live their own lives.

"With a Capital Depletion Forecast you always know where you are, as far as assets and expenses go, so if you overspend one year, you know that you'll need to cut back the next," says Roberts. "The sooner you start planning, the better."

The Biggest Mistake People Make

Not planning for their loved one's decline is actually the biggest mistake people can make. Roberts insists that the family needs to start having these conversations concerning long-term care when parents are in their 70s.

"Some seniors are in their 80s and they say, 'I never want to go to a nursing home,' but you never get to that thorny issue without having the conversation," says Roberts.

"It's better to discuss it upfront because if you don't, there will be all kinds of guilt later and when parents become ill, they become irrational. You want to discuss it when elder decline is a long way off and you have to have the money conversation. You have to know if they have the money or not."

Roberts will tell you the money conversation also includes passing the financial baton and having the will in place, while setting up the power of attorney.

"People have to be given the information in order to manage the funds correctly and the legal documents need to be in place, so when people don't plan all kinds of heartache and family feuds befall them when it comes to the best course of action. Everything is a mess when you don't plan."


Take the first step to proper elder care planning by buying 'Doris Inc.: A Business Approach to Caring for Your Elderly Parents.' You can even download your own Capital Depletion Forecast.