Case Study: How We Help Families

Client Summary

Carl is an 87-year-old widower who lives alone in a rather large home. Carl thinks he’s doing well, but he needs help with paying bills. Carl’s son lives in the Washington DC area and agrees Carl needs help paying bills and doing his taxes. His son is also concerned that he won’t be able to get to his father to help in an emergency.


Carl has asthma, heart disease; he smokes cigarettes and walks with a cane. He uses a motorized cart to get groceries and takes small bags into the house a little at a time. Carls son has arranged for the sanitation workers to get his garbage at the side of the house. Carl’s home is not clean, and there are maintenance concerns. Carl has a Long Term Care insurance policy that has been approved use for $160 per day for four years of care in the home or assisted living, but Carl wants to save it in case he needs it in the future. Carl doesn’t feel that he needs help in caring for himself at home. Carl will allow the IKOR Financial Advocate to help with paying his bills and taxes because he acknowledges that his wife always attends to routine financial matters.


The IKOR Managing Director and Carl have a friendly rapport, but Carl does not think he needs an RN Advocate to support him. Carl’s son is interested in having someone come to his father’s home or hospital in an emergency, but Carl doesn’t think he needs this type of help. Carl does want IKOR to help him with paying his bills and organizing his income taxes to go to the accountant. His utilities have been shut off a few times, for non-payment and Carl’s son had to get involved and set up the important utilities on autopay. Carl’s son has his own family and a job that requires him to travel, so taking the time to untangle the utility concerns several times for Carl was frustrating to his son.

In most cases, it takes some time for us to develop a trusting relationship. Although the IKOR Managing Director felt that Carl needed an RN Advocate to support him, she tries to work with him over time to facilitate change.

• The IKOR Managing Director agrees to help Carl early on because he was functioning well enough, but not ideally. The Managing Director feels that there are some safety concerns, home cleanliness issues, and maintenance issues that need to be addressed in the home.

• Carl’s son encourages Carl to accept the recommendations that the Managing Director requires to take the case, and Carl eventually agrees. The IKOR team, the son, and Carl, work together to get the safety, cleanliness and maintenance issues addressed.

• In the initial meeting with IKOR, Carl states that he wants to save his money for his son and his family; he believes it isn’t necessary to spend money to pay for his care. Carl admits that living alone is becoming more difficult, but he can manage on his own without assistance.

• The IKOR Financial Advocate and Carl’s Financial Advisor work together to try to help Carl realize that he will have enough money to leave for his son and pay for his care. They recommend that Carl meet an attorney about Estate Planning. IKOR also explains to Carl that his Long Term Care policy has ample value, and he can stop paying the considerable premium once he starts using the policy. Carl still does not want to use the policy or bring caregivers into the home to help to support him.

• Carl does allow the Managing Director to take him to visit a Continuum of Care Retirement Community and an Assisted Living Apartment Community. He loved the outing and the communities, but he decided that he is not ready to give up his home. The Financial Advocate works with the Financial Advisor to show Carl the cost savings of moving into a community and the benefits of using his Long Term Care Insurance to pay for his expenses. Carl decides he wants to maintain the status quo, for the time being.

• Carl agrees to have the RN from the Long Term Care Insurance Company to evaluate him after many conversations with IKOR and his son. Still, in the end, he decides he doesn’t need help. The Long Term Care Nurse assessor agrees Carl needs help with his Activities of Daily Living to be safe, and the Long Term Care insurance policy is approved. Carl still thinks he doesn’t need the help and will not accept it.

• Within days of the approval for the long term care insurance, Carl has a fall, and he is trying to hide it. The IKOR Financial Advocate noticed he was struggling and in pain. The Financial Advocate probed inquiring further and called the IKOR Managing Director on the phone to consult. The IKOR Managing Director called Carl’s son and had a hard conversation with him. Then she called Carl and had a similar conversation with him. It turns out that when Carl fell, he broke two ribs. Carl’s son flies into town for a month, using all of his vacation time, because Carl refuses to have an IKOR Nurse support him and he refuses to accept care in the home. Carl eventually allows the IKOR Managing Director to make a Home Care referral when he realizes his son needs to return to work and to his family. Carl agrees to home care four hours per day, four days a week, which is covered by his long term care insurance policy. It turns out that he likes the socialization and support and he looks happier and better than ever.

• Carl still resists having an IKOR RN Advocate to support in his care. He feels that he is more likely to lose independence if a Nurse reports to his Doctor the areas in which he struggles. The Managing Director explains that that is not the case. The IKOR Managing Director helps Carl to understand that an RN Patient Advocate will be able to support in areas in which she can not. Carl’s medical needs and safety concerns are more complex than they were when IKOR came on and the Managing Director feels she will do a disservice to Carl if she doesn’t insist on having someone with more medical training support him.

• The IKOR Managing Director and Financial Advocate meet with Carl and his son with the Financial Advisor and an attorney. IKOR’s position is that unless Carl agrees to have an IKOR RN Advocate to support him in medical and safety-related areas, with a consistent home care provider in the home, IKOR will need to resign from supporting him. Carl has developed a terrific rapport with his IKOR Financial Advocate and he doesn’t want to lose that relationship. Carl’s son understands why IKOR has made this decision, and he explains to his father that he can’t take more time from work, or he will lose his job.

• Carl and the IKOR Managing Director eventually agree to a package for ongoing care with an RN Advocate overseeing his care. The IKOR RN Advocate is working with Carl’s son to address current medical concerns and to help Carl understand his option within Assisted Living Apartment community when he is ready to move or when a care crisis requires a move. Carl still states the highest priority is not to spend money on his care. Carl’s long term care policy will pay $160 per day for care in the home, which is about 6 hours per day, and that is working for him. The IKOR Financial Advocate creates a budget for Carl on his monthly expenses living at home and the monthly cost of $5800 per month for maintenance of the home. The Financial Advocate shows Carl that the Long Term Care Policy will pay for an apartment in an Assisted Living Apartment and cover all of his expenses for $5700 per month for four years without spending any of his assets. Carl’s son is his Durable and Medical Power of Attorney; he recognizes that his father is not functioning optimally. Still, Carl is not open to accepting more help or to consider moving to a care community.

IKOR’s goal is to support the client’s wishes. As long as Carl is safe and as long as he can afford what he is requesting, IKOR will work to find a way to make Carl’s vision happen. Even when Carl’s financial advisor, his son, and an attorney have assured him that he can afford the care he needs in any living situation, Carl is uncomfortable considering any change in his circumstance. The IKOR Managing Director, RN Advocate, Financial Advocate, and Personal Needs Coordinator plant seeds with Carl on each visit to help him to understand his options and move forward when he is ready.

Helping seniors and families understand their options in complex care situations and helping them make decisions on how the cost of care will align with financial goals are one of our area of expertise. The IKOR team continues to help Carl to understand how he can align his care-related needs with his Estate Planning goals. IKOR’s goal is to help Carl to adjust to the changes in his ability to function independently and improve the quality of his life and be there to support in an emergency by going to the hospital and reporting to the son as needed.

Disclaimer: This case study is a combination of several clients IKOR has supported to maintain the privacy of our client. It does not include the exact details of how we have helped clients like Carl. If you would like to understand more specific information about how IKOR has supported the care of clients like Carl, please call our office to schedule a no-cost consultation.

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