Caring for Aging Parents: The Conversation to Have Before You Need to Have It

Rosalynn Carter spent much of her life after the White House working on a subject many families would rather not discuss: caregiving. In 1987, she founded the Rosalynn Carter Institute for Caregivers and often said, "There are only four kinds of people in the world: those who have been caregivers, those who are currently caregivers, those who will be caregivers, and those who will need caregivers."

She was right about how common it is. An estimated 61 million Americans provided unpaid care to an adult or child with a medical condition or disability in the past year.¹ A person turning 65 today has close to a 70% chance of needing some type of long-term care.² So for most families, the real question is not whether a parent will need help. It's when you'll talk about it: before anyone has to decide the details, or after that moment has arrived.

When a crisis sets the schedule

When a parent is injured or gets a difficult diagnosis, clinicians can end up driving the decision-making for you. Where will Dad recover? Who will stay with Mom when she can’t be left alone? Do their savings cover associated costs of care? Questions like these deserve weeks of thought and supporting research, but in a crisis, families get only days or sometimes hours to make them. In such moments, they decide with whatever information is on hand, not a well-informed set of options developed when clearer heads prevail.

At EP Wealth, we see this scenario all too often. Families make careful, loving choices under that pressure and still wonder afterward whether it was what their parent would have wanted. Those are the moments that stay with us, and they’re why we encourage families to have difficult conversations early, not when it’s too late.

Take a father in his 70s who still does his own taxes and drives across town every Sunday to see the grandkids. Each visit when his daughter brings up "someday" at dinner, he adeptly changes the subject. After all - he's fine right now. But three years later when he has a stroke, every question has to be answered at once, and he can't fully weigh in. His children spend those emotionally turbulent days guessing what he'd want, when what they want most is to hear his wishes clearly firsthand.

Plenty of families start this conversation while they're already dealing with a health scare, a long distance, or a strained relationship. The ideal scenario is having it while no one is in crisis, so your parent can say what they want in their own words and everyone can fully listen.

Why sooner matters, even when nothing is wrong

There's another reason not to wait, and it's harder to talk about. Some change in memory and thinking is a normal part of aging, even for healthy adults. Researchers have found that the ability to make sound financial decisions tends to peak in a person's early 50s and declines gradually after that.³ Among Americans 65 and older, about 1 in 10 have dementia, and about 1 in 5 have mild cognitive impairment, which can go unnoticed for years.⁴

That changes what “before it's necessary” really means. The best time to talk is while your parent is of sound mind and body, thinking clearly and able to explain what they want and why. Once physical or mental decline sets in, even slowly and without any crisis, the conversation gets exponentially harder, and some options start to close. Signing a power of attorney or a health care directive, for example, requires a parent to be legally capable of making that decision. If that point passes, a family may have to ask a court to appoint someone to decide for them.

The encouraging part is that the steps that protect a parent here are familiar and manageable: a durable power of attorney, a health care directive, and an honest conversation about what they want. Put in place while a parent is well, they give the whole family something solid to lean on later.

The costs that show up as bills, and the ones that don't

Families tend to underestimate what care costs, partly because so much of it never arrives as a bill. It shows up as time. A daughter cuts back to part-time so she can shuttle Mom to appointments. A son depletes his vacation days to be present for an extended hospital stay. A brother across the country spends his evenings on hold with the insurance provider.

The bills are large on their own. A private room in a nursing home now has a national median cost of $129,575 a year. Assisted living runs about $74,400 a year. In-home help for 44 hours a week can cost $80,080 a year, or roughly $35 an hour.⁵ Money a parent saved for travel, grandkids, and their own good years can end up paying for care instead. When it runs short, adult children often cover the difference.

Many families assume Medicare or a long-term care policy will handle most care needs, like a magic wand waved over the situation. In reality, it’s more common that neither resource covers as much as people expect or on the timeline when it’s needed. Medicare, for example, doesn't pay for help with everyday needs like bathing and dressing when that's the only care someone needs.⁶

Memory care is often where that gap is widest. When a parent with dementia needs a secure setting and specialized staff to care for them around the clock, Medicare generally won’t pay because it’s considered custodial care. Memory care also tends to cost more than standard assisted living. Even a long-term care policy may cover only part of the bill, and then only after a waiting period and up to a daily limit. Even for families who project and plan for physical care needs, memory care can become the largest expense they never saw coming.

There is one bright spot many families miss. For someone who is chronically ill, much of the cost of memory care or assisted living may count as a deductible medical expense once total medical costs exceed 7.5% of adjusted gross income.⁷ That deduction can offset much of the tax on money a parent withdraws from an IRA to pay for care.

Being aware of such financial gaps and tax saving opportunities early gives your family more options. You have time to compare care choices, tour communities in person, get on waiting lists where necessary, decide which assets would pay for care and in what order, and find out whether long-term care insurance is still an appropriate option based on a parent's age and health. That order matters more than many families realize. Withdrawals from a traditional IRA or 401(k) count as taxable income, and selling investments can trigger capital gains taxes, but selling the family home may be largely tax-free: up to $250,000 of gain for a single owner, or $500,000 for a married couple.⁸ In this issue's Fall Ask a Planner, we dive into more detail about these expense topics as we answer questions from families who found out their parents' coverage fell short.

Planning ahead is something a parent gives

It’s easy to understand why parents bristle when their kids try to broach this difficult subject. When a grown child asks about future care, it can sound like the start of losing control over their home, finances, and independence. No one wants to feel managed by their own kids.

But in our experience, the conversation tends to change when a parent is open to shifting their mindset. A parent who says where they'd want to live if they needed help, who they'd want making decisions, and how they'd want their money used is actually the one controlling the decisions rather than giving them up. Some parents find it also helps to reframe the scenario as the ultimate gift they can bestow on loved ones: “I'm giving my children the gift of peace of mind." For their children, every wish said out loud is one less thing to wonder about at a hospital bedside, argue over with a sibling, or second-guess for years afterward.

Take a couple in their early 70s who invited their three grown children to dinner with an unusual request: put your phones away, we have some things to tell you. Over the next two hours, they had an open and honest conversation where they walked through where they’d want to live if they needed help, which child they trusted with which decisions, and where to find every document that might be needed. They even agreed that if either of them ever needed memory care, the house would be sold to pay for it. Each child went home with a copy of the same folder including pertinent details. It was awkward for about 10 minutes. Eight years later, when their mother’s memory began to slip, the family still had hard days. But they never had to guess what she wanted or how to pay for it, and they never had to argue about it. She had already told them.

Start with their life, not their health

If you're the adult child trying to initiate the conversation, it can help to state your intentions plainly: "I'm not trying to take anything away from you. I want to make sure we get this right, your way." Or start with your own planning: "We just updated our healthcare directives, and it made me wonder where yours stand."

The first conversation doesn’t have to cover everything; in fact, it usually shouldn’t. It tends to go better when it starts with how your parent lives now: the friends they see, the routines they love, the things they’d hate to give up. Those answers tell you what any plan needs to protect.

It also helps to let the conversation happen where it naturally can. Some of the best ones start in the car on the way to an appointment, or while cleaning out the garage, rather than at a formal family meeting. One daughter got further on a two-hour drive with her mom than she had in a year of trying to schedule “the talk.”

Expect it to take more than one try. If your parent shuts the subject down, that’s their answer for today. Let it rest, and come back to it. Try to listen more than you talk. Repeating back what you heard shows your parent they were understood, which makes the next conversation easier.

When you’re ready for specifics, this issue’s Well Said: Caring for Aging Parents conversation guide offers five questions to talk through together, when the opportunity presents itself.

Find the paperwork before you need it

The call you never want to get: your father has fallen and broken his hip. In the scramble to get him off the floor, out of pain, and into the ambulance, a paramedic turns to you and asks what medications he takes. You don’t know. He’s too disoriented and panicked to tell them himself, and his pill bottles are spread between the kitchen counter and the bathroom.

The days that follow can bring a different problem. When one mother was rushed to the hospital, her three children knew she had a health care directive. However, it took them two days and many calls to find it, only to discover that it named their father as the person to make medical decisions for her. He had died six years earlier.

EP Wealth’s planners and advisors have taken calls like these from clients too many times. We stand ready to help families through them, but we’d much rather help them prepare, because we’ve seen how differently the same moments go when a family is ready, not reacting: a son standing in his mother’s hallway, reading her medication list to the paramedic from his phone in under a minute. The good news is that most of that preparation is simpler than you might expect.

Start with a current list of your parent’s medications, doctors, and allergies, and make sure more than one person in the family can pull it up on their phone. Then ask your parents where their key documents are: the will, powers of attorney, health care directive, and insurance policies. For each one, ask three questions: Does it exist? When was it last updated? Where is the original? If something is missing or out of date, that gives you a natural way into the bigger conversation. Finally, agree on one place where the family can find everything.

Share the work on purpose

Two sisters, one 15 minutes from their parents and the other three states away, never really decided how they’d split their parents’ care. It just happened. The sister nearby started driving their dad to appointments, then picking up prescriptions, then handling repairs around the house. Two years in, at Thanksgiving, she told her sister she was exhausted (not to mention feeling resentful of her larger share of the burden). Her sister had no idea. Every weekly phone call had sounded fine.

They sat down with their parents that weekend and divided things up. The sister three states away took over the bills, the insurance calls, and the pharmacy orders. She began covering part of their dad’s in-home care, too, by paying the agency directly. Payments made directly to a care provider for qualifying medical care don’t count against the $19,000 annual gift tax exclusion.⁹ She also started flying in for a long weekend every few months so her sister could get a real break. Their parents’ needs hadn’t changed. What changed was that everyone could finally see the whole picture.

Many families will recognize some version of this. The work tends to land on whoever lives closest unless someone decides otherwise. Naming the jobs out loud, from rides and repairs to bills and doctor’s visits, is usually enough to start sharing them.

Who sets the timeline

Think back to the father who changed the subject at dinner. Now picture his daughter trying again a few months later, while they’re fixing the fence in his backyard. This time he answers. He wants to stay in his house as long as he can. He trusts his son with the money and his daughter with medical decisions. He’d rather spend his savings on help at home than leave it all to them. None of it is written down yet, but now it can be.

Rosalynn Carter’s four kinds of people will describe nearly every family at some point. Planning won’t change that. It changes who sets the timeline: your family, while your parent can still speak for themselves, or a hospital’s discharge date and the fine print in an insurance policy.

We’ve walked alongside many families through the hardest version of these moments, and we’ll be there to help if you find yourself in one. But we’d much rather help you get ahead of them. Planning won’t make aging painless. It does take much of the panic, guesswork, and family strain out of it.

This conversation won’t be easy. It will be easier now than it will be later.

Whether you’re just starting this conversation, in the middle of it, or facing a decision right now, talk to your Advisor about the ways we can help your family navigate it.

EP Wealth is here to help you be there for the moments that matter most to the people you love.

DISCLOSURES

¹.  AARP and National Alliance for Caregiving, Caregiving in the US 2025.

^2. U.S. Department of Health and Human Services, LongTermCare.gov.

^3. S umit Agarwal, John C. Driscoll, Xavier Gabaix, and David Laibson, “The Age of Reason: Financial Decisions over the Life Cycle and Implications for Regulation,” Brookings Papers on Economic Activity, 2009.

^4. Jennifer J. Manly et al., “Estimating the Prevalence of Dementia and Mild Cognitive Impairment in the US,” JAMA Neurology, 2022.

^5. CareScout, 2025 Cost of Care Survey.

^6. Medicare.gov, “Long-term care” (custodial care exclusions).

^7. Internal Revenue Service, Publication 502, Medical and Dental Expenses.r.

^8. Internal Revenue Service, Publication 523, Selling Your Home..

^9. Internal Revenue Service, Instructions for Form 709.

This article is provided for educational purposes only and should not be construed as tax, legal, insurance, or investment advice. The individuals, families, and examples described in this article are hypothetical and provided for illustrative purposes only. Medicare rules, costs of care, and estate planning requirements vary by state and are subject to change. EP Wealth Advisors does not provide tax or legal advice. Please consult your tax and legal professionals regarding your specific situation.