It doesn't take a doctor to know we are living longer. Doctors, of course, see it in their offices, clinics and operating rooms everyday. Lawyers know it too, because we have 80 year old clients managing financial and medical decisions for their 100 year old parents.

So what should our respective professions do about it?

First, we need to acknowledge the need to plan for aging and declining capacity before it becomes an issue for ourselves or a loved one. Unfortunately, you are probably reading this article because the effects have begun in your own family, so I am not going to take any time in this article to discuss the statistics of why we should plan for this contingency well in advance of its onset. I would merely observe that the biggest issue in estate planning for most clients was "What happens when I die?" Today, the biggest issue is "What happens when I don't die?"

Let's start with our parents. As professionals, most of us are the alpha children in our families. ... the ones our parents and siblings look to for help when they can no longer handle a personal, medical or financial challenge. We have intelligence, education and resources, and don't lose our wits when we are led by circumstances to put ourselves and our judgment on the line.

There is no solution as good as managing one's own affairs. Our challenge is to figure out what to do when that is no longer possible. The answer is intuitive and logical. Only the protocol and implementation is elusive. Here is how it is done; or at least how it is best done with the available knowledge, laws and tools.

First is fact-finding, a sort-of personal, medical and financial x-ray of the situation. Second is to develop a care plan. Third is to assemble an interdisciplinary team to implement and monitor the plan.

Personal What are the inter-family relationships? Who gets along - or perhaps more importantly, doesn't get along - with one another? Is there are natural leader in the family to whom everyone turns? Are there jealousies? Are their meddling in-laws to clutter up the communications and decision-making? Interestingly, even the most accomplished children can't always ask these questions of parents, because the parents remember the children as infants and toddlers and, worst of all, teenagers. It is often difficult for parents to open up to their children about their thoughts and views of other family members. Most "Elder Law" attorneys are fairly comfortable leading this discussion, but doctors probably need specialists who are trained and experienced in both Elder Law and in comprehensive estate and tax planning for financially successful doctors. Attorneys with the skill and knowledge to counsel and plan in both arenas are available, but in our experience there aren't many. If you need to work with counsel in a specific location, we may be able to help you find someone.

So to handle the personal challenges, you need to find someone to lead and guide the personal discussion and fact-finding. By the way, lawyers know the value of doctors' time, but doing this properly takes time and there is no shortcut. Sometimes spouses can relieve doctors of some of the time requirement, but not all of it.

Speaking of spouses, I was once invited to attend a presentation by our local probate judge, sponsored by a female financial advisor from a major financial firm. Actually, my wife was invited to the presentation, but I knew the advisor well from my country club, so I had my wife call and ask if I could come, promising that I would sit in the back of the room and just listen. With permission, I did so. The angst in the room was palpable, because the audience was, except for me, middle age women with successful husbands - several of them doctors - who knew (a) they would probably be widows someday and needed to understand what would happen when that occurred, and (b) when parents started downhill, all the caregiving challenge would fall to them, even for their husbands' parents.

So a word to both male and female doctors who want to make sure their parents receive the best care with the least burden: Men, the caregiving burden for your parents will probably fall to your wives, and you need to make sure things are arranged in such a way as to minimize the burden on your wives and your families. Ladies, you may have already earned most of the "superwoman" designation, but you can't do everything in the available hours. Help is available. Take advantage of it.

Medical Some of you are geriatric specialists, but most of you are not. There are two components of "medical" for purposes of this article: Medical care and the legal authority to make medical decisions.

You already know many of the medical issues, of course. You are probably not familiar with all the medical care options. There is an emerging and growing group of professionals who are: Geriatric Care Managers. Most GCMs are former nurses, PTs and OTs who, for a variety of reasons, have left direct patient care and are now assisting families with assessing, arranging, providing and managing care for aging or special needs persons. Most of our clients are financially successful, but many of their parents are not, and sometimes they have special needs children or grandchildren, and need guidance and assistance in providing for them. GCMs know the alphabet soup of elder care programs, both means-tested and universally available, and can help qualify seniors for those programs. They know every elder care facility and facility manager in their communities. They can monitor meds and feeding and rehab therapy. And they can do so better than children precisely because they are not the children. Your parents, especially your fathers, are often not honest with you because they are not good at acknowledging vulnerability. We as children call them stubborn. GCMs know they are just striving to maintain their independence, trying not to be a burden.

My wife and I have engaged GCMs to work with our parents, and still work with one periodically to assist my wife with decision-making and care of my mother-in-law. The value of her assistance far exceeds the cost.

The legal side of medical care for aging and declining elders is ever-changing and far more complicated that it once was, owing both to the extraordinary advances in medical science and the frustrating efforts of plaintiff's attorneys and those who hire them.

Basic health care documents - Living Wills and "Durable Powers of Attorney for Health Care" (known by varying names in different states) and are necessary, but by themselves no longer enough. In my state, the standard form health care documents do not contain a HIPAA waiver, an inexcusable omission in my view. To supplement the basic documents, our firm not only modifies the deficient standard forms, but prepares a stand-alone HIPAA waiver, and a letter from the patient to his or her primary care physician that instructs and authorizes the physician to cooperate with the family if the physician's help is needed in making medical/legal decisions. The letter includes a specific HIPAA waiver applicable to this task. We also counsel carefully about Guardianship nominations, in case court proceeds should be needed to protect the senior and his or her assets, and the persons who should be selected as agents under a General Durable Power of Attorney.

There are a small number of specialists who understand these issues, who are comfortable counseling families about them, and who have developed protocols, forms and procedures to implement their decisions

Financial Caregivers need a "financial x-ray", that is, a full understanding of each asset owned by the aging person, how the asset is owned, whether or not it has a beneficiary, how it can be accessed, etc. Assets should be consolidated, for ease of management and monitoring, with a single financial advisor who is good at working on a team with a CPA, GCM and attorney. Most financial advisors don't have the patience (or the proper staff) to worry about beneficiary designations, Medicaid trusts, VA Aid and Attendance pensions and other issues applicable to aging clients.

I was once brought into a messy estate situation where a grandmother had become guardian for two grandchildren. She had a small annuity, the beneficiaries of which were a nephew and a niece, and the rest of her sizable estate was in stocks and real estate. Over time, she put all her liquid assets into the annuity. Upon her death, most of her estate wound up going to the nephew and niece, instead of the grandchildren as she wanted, but she never thought about the annuity designation ... nor did the bank lobby insurance hawker who was more concerned about his commissions than whether the money was going to the right beneficiaries.

If you have siblings, and if the siblings have spouses, there are plenty of folks to criticize every financial decision you make on behalf of your parents. Having the right financial advisor and care team provides you with insulation from both criticism and liability in helping manage your parents' financial affairs.

Your Own Aging If you don't die of cancer or some sort of cardio-pulmonary disease, you are statistically likely to experience the ravages of dementia, alzheimers or other forms of declining capacity. You owe it to your families, patients, employees and partners to plan for it. Doing so is only a minor extension of the comprehensive planning you should be doing anyway, so doing it is not a big deal. Having done it, however, is a very big deal for those about whom you care and those on whom you are going to rely for your care should you ever need it. By the way, it is too late to plan after you begin declining. As one of my colleagues says to clients who are reluctant to do complex planning because they think they are too young and can do it later: "These things are too complicated for 95 year olds to do. The problem is, not all my clients turn 95 at the same age."

Summary For a 65 year old couple, there is a nearly 50% chance that one lives to 95. Most of us are going to live to ripe old ages. Not all of those years will be good ones. Protocols, processes and people are available to improve the lives of aging persons, and ease the burdens on the loved ones who must care for them. It takes time and money to get it right, but doing so is a priceless gift to everyone involved. If you are a prospective caregiving with a spouse, children, a medical practice and a life outside caring for your parents, you should take advantage of the advisors and tools available to improve your parents' (or your own) care while minimizing the burden on those you love.