Caring for Aging Parents

  • Caring for elderly parents is a major concern of many Foreign Service families. How to ensure good health care, find the right living situation, and handle legal questions is often complicated for Foreign Service families while serving on overseas assignments. While it is difficult to discuss sensitive issues of aging, families who have agreed on plans will be better able to handle situations that may arise. It will be worth the time taken to research topics such as how to communicate with your aged loved ones, medical insurance, eldercare housing options, finances, legal issues, etc. before there is an emergency.

Elder Care Resources


WorkLife4You is the Department of State’s 24/7 Employee Assistance Program (EAP) for  employees and their family members. WL4Y will help employees and family member find programs, providers, information, resources and guides for all kinds of life events to include caring for aging loved ones. Call them for 24/7 personalized assistance, read articles and educational guides on their website, order topic related kits, engage in monthly live talk, watch webinars and listen to audios or ask for a free in-person elder care assessment from a qualified Professional Care Manager.

The WL4Y Emergency Backup Dependent Care provides 24/7 access to specialists to arrange care in advance or at the last minute for your aging loved ones. WL4Y provides up to five (5) days of adult backup care with a  low co-pay if you use a nationwide care center or 100% reimburse if you use friends or family members.

Department of State, both Civil Service and Foreign Service employees and family members are eligible to use WorkLife4You. For login information, contact FLO at

*USAID employees and family members are eligible to use USAID Staff Care.

** Employees of agencies other than the Department of State should check with their headquarters for guidance pertaining to their contracted Employee Assistance Program.

The Employee Consultation Service (ECS)

The Department of State Employee Consultation Services (ECS) provides confidential services to assist Foreign Service Officers and Civil Service Employees, who may be experiencing professional or personal life challenges. They offer services face to face, video, or telephonically, both domestically and abroad.  ECS also conducts eldercare support groups for employees and their families who are responsible for an aging relative. The groups meet at the State Department to share issues, resources, and approaches to the problems that arise as an elderly person declines, including the issue of emotional stress that occurs for family members watching such decline. Email:

* USAID employees and family members should contact USAID Staff Care.

Additional  Resources

The Family Liaison Office (FLO) resources do not constitute an endorsement or recommendation of any particular organizations by FLO or the Department of State.

Federal Long Term Care Insurance Program 
The Federal Long Term Care Insurance Program (FLTCIP) provides long-term care insurance for its enrollees, who are Federal and U.S. Postal Service employees and annuitants, active and retired members of the uniformed services, and their qualified relatives.

The American Foreign Service Association (AFSA)
Retiree  Services

Putting Parents on Your Orders

Foreign Service employees may request that their elderly relative(s) (including step parents and legally adopted parents) be approved as an eligible family member and added to their Post Assignment Travel Orders for an overseas assignment. The employee must complete an OF-126 Foreign Service Residence and Dependency Report. Each new OF-126 replaces the old OF-126; therefore, all blocks must be filled out each time a new OF-126 is done. The new OF-126 must be forwarded to the employee’s HR Technician. Travel orders cannot be authorized for newly-acquired eligible family members until the HR Technician receives the OF-126 form.

Along with a completed OF-126 form, the officer must prove that the relative has resided with the employee for at least 6 of the last 12 months, with some exceptions noted in 14 FAM 510, is at least 51 percent dependent for support (subject to review and approval per 14 FAM 510; USAID employees should also see Supplement 1B to HB 32, Chapter 1). The officer must quantify that he/she has provided more than 51% of support by submitting an affidavit or notarized statement testifying to that fact. This is termed passing the “financial support test.” An explanation regarding the parent’s residency is also required, with an explanation as to why the application is being made to add the parent to the travel orders. Other documentary evidence may be required by the employee’s agency. These documents are attached to the completed OF-126 form and sent to the officer’s agency as specified on the forms. Requests are reviewed for approval by a Personnel OF-126 Committee. Note that the parent may only be on orders as an EFM for one tour. The employee must reapply for another overseas posting.

Employees of the Department of State can obtain advice on how to put their parents on orders through the Career Development and Assignments (CDA) division. Ask for an Assignments Support (CDA/AS) officer. Employees of other agencies should contact their HR representative.

Bringing Parents to Post Who are Not on Your Orders

Parents may also travel to post as Members of Household (MOH) but will receive minimal official support from the U.S. Government. MOH parents are responsible for acquiring their own visa for entry and residence in the host country. Upon request, the Human Resources Office at post may assist in the process in accordance with local laws. Some countries require additional documentation by the accredited employee and all countries hold the authority to approve or deny any visa. Furthermore, they do not have diplomatic status with the host country and are not entitled to access the U.S. embassy or consulate health units. However, the Health Unit may provide them with a list of referrals for local medical professionals. Finally, MOH parents are not eligible to receive airfare or allowance payments in the case of evacuation from post.

Family Medical Leave Act and Family-Friendly Leave

If you think you may need to care for an elderly relative, be sure to check the provisions of the 1993 Family Leave Act on taking leave for this purpose and contact the a leave specialist in your agency. Department of State employees can contact a Department leave specialist in the Office of Employee Relations HR/ER/WLD about paid and unpaid leave.

Department of State employees may request a free copy of FIVE WISHES from the Office of Employee Relations, Work/Life Division (by email to ER/WLD on the global address list). FIVE WISHES is a planning tool and legal document in most U.S. states that combines the features of a living will and a health care power of attorney.

Eldercare Emergency Visitation Travel (Eldercare EVT)

In January 2001, the Eldercare Emergency Visitation Travel (Eldercare EVT – 3 FAM 3742) provision was implemented, permitting travel at government expense for employees and eligible spouses serving at an overseas post who need to assist parents in declining health. Eldercare EVT allows the employee two trips over a career to visit his or her parents. It is meant to support one mother and one father of the employee and of the eligible spouse. It does not mean a couple may pool their four eldercare visits to assist the parent(s) of only one member of the married couple.

Taking an Elderly Relative to Post

If elderly relatives are classified as eligible family members, they may travel on diplomatic passports and may have the same diplomatic immunity as a spouse or child; however, this is subject to the laws and policies of the host country of assignment. If not classified as such, elderly parents use tourist passports and do not have diplomatic status. In either situation, the host government of the country to which the employee is posted may have their own policies, rules, and conditions for granting the diplomatic visa or resident status to the parent. It is incumbent on the employee to advise post in advance and find out if there are any specific host country restrictions or additional conditions.

Housing assignments are based on the number of official eligible family members the employee brings to post. Travel to and from post (with the exception of medical travel) is also available to all elderly parents designated as eligible family members.

Elderly parents, regardless of their status, are not covered by the Foreign Service medical insurance program and do not have access to the health unit. Employees may, however, ask the Health Unit for names of local physicians who can provide medical services for their elderly parent. This kind of assistance from the Health Unit may also be requested during the bidding process, to determine if a post has adequate local health care providers to meet the medical needs of a parent.

Because elderly parents are not covered under the Foreign Service medical insurance program, they also do not have access to embassy medical evacuation (medevac) services. Therefore, all parents coming to post for either a short or an extended period of time should purchase (and maintain) Air Medical Evacuation Insurance. A list of companies that provide this insurance can be found on the Department of State Consular Affairs website.

Medical Insurance

It is essential that a parent going overseas, either officially or unofficially, have adequate medical insurance. Medicare only pays medical expenses in the United States and in Canada and Mexico under limited circumstances.

The insurance companies listed below provide a variety of coverage and can be contacted for more information. Pay special attention to “age limit” noted in the policy.

Clements Worldwide
Under its GlobalCare Plus program, Clements Worldwide provides overseas major medical insurance, including full world-wide evacuation services. Coverage is offered for individuals and families. Substantial coverage is available at a reasonable cost. GlobalCare Plus is for policies lasting 6 months to one year. Clements also write policies for shorter-term travel (15 days to 4 months) through Patriot Travel Medical Insurance.

Blue Cross/Blue Shield
Provides coverage to Americans living abroad only through the local offices where the clients have residence. Insurance may be purchased while the client is overseas. CareFirst BlueCrossBlueShield (Washington, DC Area)

International SOS
Provides only supplemental coverage including a hospital deposit repay, medical referral, evacuation to facilities for treatment, legal assistance, and a toll-free hotline. Medical centers are located throughout the world.1-800-523-8930 or 215-244-1500

If Your Elderly Relative was a Foreign Service Employee or Spouse

Senior Living Foundation

The Senior Living Foundation of the American Foreign Service, sponsored by the American Foreign Service Protective Association (AFSPA), provides information and assistance to retired Foreign Service personnel and their surviving or divorced spouses and, on the basis of need, helps to defray the costs of home health care, senior housing facilities, long-term care insurance, or other services that contribute to their health and security. The Foundation is especially concerned with the 14 percent of the 11,000 retired members whose small pensions keep their income at or below the poverty line.

The Foundation’s Resource Center provides information about and assistance in obtaining community, State, and Federal resources. A licensed clinical social worker with Foreign Service experience reviews each case to determine the best resources available for the individual. Help ranges from volunteer visits to long-term care planning to advice on the legal maze of Medicaid.

U.S. Department of State

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