New York Elder Law Attorney Blog

Over the last few years elder care advocates have issued a steady drumbeat of concern: mistreatment of seniors is on the rise. The rates of neglect and abuse are not necessarily rising, but the total number of seniors affected are--a product of the changing demographics. The problem is only expected to get worse in the coming years.

It is important to keep in mind that research consistently shows that even "minor" forms of neglect can prove deadly. The U.S. Department of Human Services' Administration for Community Living points out the stark difference in morbidity rates for abused versus non-abused seniors. Even when split only between those who received adequate care and those who received "modest forms of abuse" there is a 300% increase in the death rate for the mistreated seniors.

In other words, even small difference between the quality of long-term care facilities--both nursing homes and less-intensive assisted living facilities--can have life or death consequences. All of this makes the process of choosing a proper facility a critical task for seniors and their families.

Senior Care Advocacy Program
Fears about a rise in elder neglect is leading the Administration for Community Living to propose more detail guidelines regarding the operation of Long-Term Care Ombudsman (LTCO) programs. The programs have been around for decades in every state, including New York. They are intended to act as a counterweight, advocating for the public policy interests of nursing home residents.

However, in recent years many have voiced concern about a haphazard approach to LTCO operations. There is not much uniformity in the roles of advocates and volunteers. There are also different approaches to how resident complaints are handled and the proper way that the ombudsman should mediate possible conflicts.

To address these concerns, the Administration for Community Living recently announced its plan to release more detailed instructions to provide clarity on the role of these programs. The specific proposed rules are set to be released this week. After that, a sixty day window will open where members of the public can provide comment on those possible changes. The specific proposal can be found here.

Hopefully greater clarity in this regard will ensure that all New York resident in these living locations have access to the quality advocacy they need to prevent mistreatment and demand accountability following abuse.

If you or a family member has questions about what preparatory steps can be taken now to plan ahead for possible long-term care needs in the future, please contact our team of NY elder law attorneys to see how we can help.

One overlooked aspect of elder caregiving is the difficulty of the transition time itself. While some seniors may suffer serious medical events (stroke, heart attack, etc.) which require adult children to manage affairs overnight, in many cases the need for support happens only gradually. This presents a challenge as children must delicately broach the topic with parents who may be uninterested in change. At the same time, sibling rivalry, hurt feelings, misunderstood intentions, lack of information about savings, and many other details are thrown into the mix.

Put another way, before even deciding the best way to provide "financial caregiving" for an elderly parent, one must first figure out when to begin and how to get the parent to concede that help is needed.

A CNBC article last week examined this sensitive subject. The article provides reasonable advice while noting that "the shift [to financial caregiving by adult children] can be less stressful if everyone takes it slow, seeks advice and remembers that helping to maintain a loved one's well-being is the primary goal.

***Take it Slow: Understand that transitioning control of something as personal as one's finances is bound to be a sensitive topic. It takes time for many seniors to come around the fact that it will actually help them, instead of being an affront to their independence. Recognizing that it is common for some friction to develop when the topic is first broached will make it easier to remain calm and slowly work on getting everyone on the same page.

***Seek Advice: No matter what, you do not have to go it alone. Professionals exist who are intimately aware of all of the intricate details and sensitive nature of these elder care concerns. Those professionals can not only do the actual leg work to make plans, but they can provide helpful advice based on observing similar situations with other families. You just need to ask.

***Put it in Writing: No matter how secure one's family situation seems, it is critical to ensure financial matters are not left to chance. Disagreements are incredibly likely to arise between different parties involved when proper legal documents transferring rights to others are not created. Considering the relatively minor cost and challenge of following the proper legal steps, there is no reason to avoid this process.

For help with any number of elder law or caregiving issues in New York, please feel free to contact the experienced attorneys our firm. We have offices throughout the state and have helped thousands of families with these challenges.

It is no secret that most New Yorkers would prefer to "age in place" instead of moving into a nursing home. For one thing, having access to the comforts of one's own home and the freedom to live as independently as possible is a natural goal. On top of that, however, are the myriad of horror stories that continue to pop up regarding mistreatment, neglect, and outright abuse that is sometime perpetrated at skilled nursing facilities. If you read enough of those harrowing accounts, it is easy to get the impression that these homes are no place to thrive in your golden years.

A new story coming out of Queens offers little relief. As reported this weekend in the NY Daily News, a former director of nursing at a Queens facility is now facing criminal charges for her conduct following a resident's wandering from the facility.

Authorities explain how two weeks ago a 74-year old resident of the facility went missing. He was apparently not properly supervised and wandered out of the home without notice of the caregivers. The man has dementia, and obviously is at risk of serious harm while alone in the community. The senior has still not been found.

Generally, nursing home neglect like that which allows wandering to occur does not give rise to criminal charges (though civil lawsuits are common). The nursing home director in this case, however, apparently engaged in an elaborate attempt to cover up the facility's missteps. It is that cover-up which prompted her arrest.

In particular, the former nursing home director apparently did not call 911 immediately upon learning of the man being gone. She allegedly instructed others not to call right away as well. Instead, the criminal complaint filed in the case suggests that she removed certain medical notes from the man's charts which may have shed the facility in a poor light. She also apparently told a colleague to make up a story about the senior's leaving on his own accord against the wishes of others. It wasn't until this cover up was in place that officials were actually told of the disappearance--4 days after it happened!

Plan Ahead
It is unfair to use single incidents like this to claim that all NY long-term care facilities are bereft of proper caregivers. But it is a useful reminder of the fact that not all nursing homes are alike. There are vast quality differences, and it is critical to plan ahead so that you or a loved one is able to move into a quality home that actually meets their needs if that becomes necessary down the road.

This is a heated time for local politics, as various high-profile public officials jockey to replace Michael Bloomberg in the Mayor's Office. As part of the process, the candidates share different ideas about the challenges facing the city and the ways to fix them. This can be a helpful endeavor, focusing public attention on needed concerns and providing a burst of new ideas to, hopefully, enact change.

For example, one of the front-runners in the race, City Council Speaker Christine Quinn recently pointed to the risks faced by New York City seniors and the need for more proactive steps to keep those seniors safe. As reported in a NY Daily News story late last week, Quinn believes that a database of homebound seniors is necessary to ensure that those at-risk individuals receive the aid they need--particularly during natural disasters. This need was put in perspective following the many stranded seniors caught in the middle of Hurricane Sandy last year.

Quinn explained: "There were many reports that people were stuck in buildings without water, food, heat, and we want to be able to target those individuals. Some of these individuals were elderly or disabled, and it took the city, everyone would admit, longer than it should have to start outreach to locate them."

The Speaker's specific proposal came as part of a more comprehensive planned package of bills hoping to improve New York's storm response program. The proposed bill is likely just as starting point, as it would create a task force to evaluate how to create a homebound senior list, instead of actually calling for the list right away.

Interestingly, this puts her at odds with Mayor Bloomberg who previously argued that this sort of list of vulnerable seniors would be impractical. The Mayor claimed that because of the rapidly changing senior population, creating a list would be unhelpful because it would be outdated almost instantly.

Quinn counters that while it would likely be impossible to have a perfect list of seniors in need, the presence of at least some starting point would be better than having nothing at all. In the event of natural disasters, such a list could mean the difference of life and death for those most in need, like seniors who receive at-home care.

Of course, it is unclear who will ultimately win the election or whether any of these proposals might actually be considered by city officials. At the very least, though, it is encouraging that New York elder care issues are making it into the debate. With our population continuing to age, it is critical for officials to fully discuss the many implications this will have on the city and the state.

The stigma associated with life in nursing homes remain strong. Many seniors do everything in their power to avoid moving into a skilled nursing facility over fears of the quality of life that residents experience. These are common worries, and a key reason that New York resident conduct early estate planning and elder care planning to ensure they are doing everything they can so they have quality living options if necessary down the road.

Unfortunately, progress in addressing quality of life issues at these facilities is often slow-going. For example, one of the most well-known issues affecting nursing homes throughout the country, including New York, is the overuse of antipsychotic drugs to "control" residents. These "chemical restraints" make it easier for employees to watch a larger number residents. But the drug use drastically lower the quality of life of many residents, often placing them in a stupor without the ability to meaningfully interact with the world.

The problem of chemical restraints have been known for years, and recently federal agencies pushed to tackle the issue. But, so far, the progress has been limited. As a New York World story noted, the overall decrease in antipsychotic use is modest and some facilities throughout New York continue to increase use of the dangerous drugs.

The Data
The Centers for Medicare and Medicaid launched a comprehensive to address the issue about a year ago, in May of 2012. The goal was to decrease antipsychotic use by 15 percent in a year. Now that a year has passed the result are in--and they are not encouraging. The overall national rate was only about half of the goal with an 8 percent decrease. In New York the results were even worse, with only a 5.4 percent reduction in use over the last year. The full index of data discussing the results can be found here.

While noting that any reduction is good, the director of a New York City Long Term Care Community Coalition noted, "There are still thousands of people who receive the drugs and shouldn't have."

The Dangers
The overuse of these drugs is not only a problem of wasted resources. There is very real harm that can befall a senior who is given these medications. Most notably, studies continue to roll in which show that antipsychotics pose increased risk of death for seniors with dementia. Yet, seniors with dementia continue to receive the medications, even if they do not have the conditions for which the drugs were originally developed: schizophrenia and bipolar disorder. In fact, the U.S. Food and Drug Administration now requires the labels of all of these products to include warning that their use includes a heightened risk of death for those with cognitive conditions like dementia.

The Urban Institute recently released a new survey appraising the preparation for Medicaid expansion in many different states as part of the Affordable Care Act (ACA). The analysis discusses how eight individual states, including New York, are changing their programs to accommodate the implementation of the Affordable Care Act. The findings are part of the Robert Wood Johnson Foundation's State Health Reform Assistance Network tracking program. A full online copy of the survey can be found here.

The study authors note that many states are using Medicaid "managed care" to expand eligibility. For example, as discussed in the report, New York "intends to move non-dual-eligible nursing home patients into managed care." The goal is to complete the transition by October of this year. New York plans to participate in a special program to help manage care for seniors who are "dual eligible" for both Medicaid and Medicare. This includes many elderly community members. This program is know as the State Demonstrations to Integrate Care for Dual Eligible Individuals.

In addition, as part of the change, New York is switching from a voluntary managed care enrollment to a required one. In the past providers could participate if they chose, but now they cannot. New enrollments requirements mandate managed care participation. Over the long-term, of course, this requirement means that more and more Medicaid participants will be on managed care.

The Urban Institute study also provides a succinct summary of New York's overall Medicaid Managed Care Program. Of interest to those working on elder law issues, it is explained how the state contracts with different health plans to provide support to certain unique populations with long-term care needs, like those with HIV/AIDS among others.

A summary of the report from The Hill, notes how New York's Medicaid enrollment is expected to increase by about 23% in the next eight years. This places the state on the lower end of the projected expansion as a raw percentage when compared with other states. However, that is likely because New York already leads the pack with Medicaid enrollees, so there is less room for an increase.

It is important to reiterate that while discussion surrounding Medicaid expansion as part of the AFA has been raging for several years, we are still very early in the implementation process. That means that many different changes are yet to be fully realised. Local seniors and their families with questions about New York Medicaid eligibility or possible changes that may affect them should contact professionals for tailored advice.

Senior financial exploitation funnels tens of millions of dollars away from seniors in New York and throughout the country each and every year. The problem has only exacerbated in recent times as the economic downturn spurred more fraud and the country's aging demographics made more targets.

One way to help a senior in need, particularly those with more advanced challenges, like Alzheimer's or dementia, is to go to the court to seek actual guardianship of the loved one. Court-appointed guardians are able to make many decisions on the senior's behalf, with the hope of preventing the elderly community member from being taken advantage of by others.

Yet, it is becoming obvious that some guardians not only fail in their duty to protect seniors--but actually neglect and exploit the very people in their care.

Legal guardians obviously have tremendous power over those relying on them. And when the guardian has ill-motives, they are well-positioned to decimate a senior's health, finances, and spirit. The misconduct is tragic, and more policymakers are working up ways to prevent this form of abuse.

Proposed Federal Legislation
For example, a bipartisan group of lawmakers recently introduced the "Court-Appointed Guardian Accountability and Senior Protection Act." The main thrust of the bill is to amp up oversight programs for guardians so that fewer individuals who are likely to exploit actually become guardians (or stay as guardians). The measure would work by providing a federal funding stream for individual state programs targeted at improving the guardianship process. Specifically, individual state courts could apply for grants that would help with background checks and monitoring. Right now, with budgets stretched thin everywhere, many state systems are unable to provide the ideal level of oversight, allowing seniors to be handed over to the care of those doing them harm.

As Senator Amy Klobuchar, one of the sponsors of the bill explained: ""Seniors deserve to live their lives safe from abuse and mistreatment. While most court-appointed guardians are undoubtedly professional, caring and law-abiding, there is mounting evidence that some guardians use their position of power for their own gain. This legislation would help increase accountability and oversight of guardians and protect those who are most vulnerable."

The likelihood of the measure's passage is currently unclear. A Home Town Source news report on the story noted that a similar bill was proposed last year without success. However, the fact that the bill has both a Republican and Democrat as co-sponsors is a positive sign that a rare compromise might be reached which could allow the bill to advance.

If you have questions about any number of legal issues affecting seniors in New York, feel free to contact our elder law attorneys to learn more.

The latest developments with the NY Medicaid program relate to concerns about the performance of the state Office of Medicaid Inspector General (OMIG). The OMIG's role is to ensure maximum efficiency of the program. Considering the constant chatter about possible program changes in order to save costs, the work of the OMIG is critical for all New York residents who rely on Medicaid assistance in any number of ways.

The OMIG identifies that its goal is "to enhance the integrity of the New York State Medicaid program by preventing and detecting fraudulent, abusive, and wasteful practices within the Medicaid program and recovering improperly expended Medicaid funds while promoting high-quality patient care."

However, many observers have grown worried that the office is not maximizing its capabilities, allowing unnecessary funds to go out, hurting the overall efficiency of the Medicaid program. Those concerns were likely amplified in recent weeks as information came out regarding the potential abuse of adult day care programs funded by Medicaid. In addition, a congressional panel recently issued sharp criticism of the NY Medicaid program. That panel noted that New York maintains the largest Medicaid program in the country ($56 billion), and that the ballooning costs may be related, in part, to poor investigation of Medicaid fraud and abuse. The federal government pays for a portion of all Medicaid services, and so federal decision-makers can play in role in state Medicaid policy,.

Considering the growing concern about the fraud prevention activity of the office, it is perhaps not surprising that the NY Comptroller's office recently announced an audit of the OMIG. In a letter to the Medicaid Inspector General, NY Comptroller Thomas DiNaploi explained that the audit would be comprehensive, examining the results of various projects from the OIMG.

In other words, the audit will try to verify some of the recent claims by the office. For example, the OMIG recently noted that an education program at local hospitals on proper billing practices led to $2.54 billion in savings. Is that accurate? The audit will hopefully find out. In addition, the audit will hopefully identify if the outside contractors who are used as part of the fraud-prevention efforts are properly utilized to maximize their effectiveness. Some are concerned that those outside contractors are being paid too much for doing too little work.

Whatever the outcome, a more efficient system that ensure New York residents do not face damaging cutbacks should be welcome by all.

Elder law issues are complex and comprehensive. Many attorneys practice exclusively in this area, because the legal issues facing the nation's growing number of seniors are very unique, encompassing many different matters, including securing healthcare, at-home support, inheritance planning, and more.

Unfortunately, some try to use generic shortcuts to handle some of these matters, instead of creating comprehensive plans that take different issues into account. For example, some many that adding a child's name onto a bank account or having a single Power of Attorney drafted are enough to solve any issues that might arise.

Examples continue to mount, however, illustrating how these shortcuts can cause serious problems. That is particularly true when disagreements arise between family members who were given various power and control over the affairs of the senior.

Evicted from Own Home
For example, the American Bar Association Journal pointed to a story this week exploring the story of one man--a 91-year old WWII veteran--who engaged in a high-profile fight to stay in his home.

The senior had given a Power of Attorney to his adult daughter several years ago. In 2004, using that legal authority, the daughter transferred ownership of the home to herself and her husband. Later, a dispute arose between the senior and his adult daughter. While details are somewhat sparse, the disagreement was rooted in visitation rights for another of the senior's children--a man with autism.

Eventually, the disagreement rose to the point where the adult daughter filed eviction papers against the senior. Because the daughter was the legal owner of the home, the man had little recourse. He had lived in the home for 56-years. The senior tried to fight back, filing a lawsuit to stay in the house. However, an appeals court judge threw out the suit, because the man was apparently aware of the property transfer and voluntarily handed over Power of Attorney.

Since then, various efforts have been waged to save the man's home, including an online fundraising drive which raised $125,000 so that the veteran could buy back his house.

No Shortcuts
It is understandable that seniors are willing to hand over control of affairs to those closest to them, like adult children. However, in most cases, it is far safer to have professionals involved. This ensures that an objective eye will be in control of affairs, eliminating even the temptation of abuse and ensuring the best interests of the senior are prioritized at all times.

The Austin American Statesman reported on a troubling elder competence case that is leading many to call for legal reforms. The story is a reminder of the heartache that may arise when feuding arises within families and relatives engage in costly legal battles.

The 91-year old's struggles began when two adult daughters told a local judge that they believed their mother was not mentally sound. They worried that she was being financially exploited and was unable to care for her own health. While perhaps rooted in good intentions, the process is an example of how senior guardianships proceedings can go awry when not done carefully.

The senior in this case lived alone until 2009. That year she broke her leg and was required to move into a senior living community. The woman was happy at the facility, and eventually one of her three daughters began helping managing her financial affairs.

Delegating the financial duties to only one daughter caused disagreement between the siblings. They eventually made allegations of abuse, neglect, and exploitation. As required, area senior protective service groups investigated the situation--appointing a guardian ad litem to look out for the senior's best interest.

The protective services investigation eventually determined that the senior was not being financially exploited and that her health was not at risk. Yet, this was not reached until after a very long back-and-forth between the parties that lasted month, came with mounting legal bills, and caused immense stress for all parties. Ultimately, mediation was required to end the matter. But it was not before the senior had to $30,000 to a court-appointed lawyer as well as $70,000 for her own private attorney. ANother $40,000 was spent by the others involved in the matter.

All of this is leading some familiar with the case to change the law so that adult guardianship cases are handled more efficiently. One advocate explained, "Before we remove somebody's civil rights, we need to make sure they are, in fact, at risk, that they are being exploited and that they are incapable of making decisions/."

The lesson: Always act as early as possible to put long-term plans in place. If outside parties truly want to make an issue out of competence, they will have more ammo to drag out a process unfairly if they can point to factors like age or illness. Even if those reasons are baseless, the appearance of some questions can cause a senior problems. The prudent step is always to act now. Make a call to an estate planning lawyer today to bring security and peace of mind.

The American Health Care Association (AHCA) is leading the effort this year as part of the official "National Nursing Home Week" which was designated as May 12th through the 18th. More information on the event can be found here.

The purpose of the Week is to raise awareness of various needs of the long-term care community. In addition, it is used by many local facilities to better connect senior residents with their neighbors. Unfortunately, there remains somewhat of a barrier between nursing home residents and others--the seniors in these facilities are often viewed as "others." Instead, many elder care advocates urge a more holistic outlook, where the skills of seniors are valued and they are viewed as an integral part of any neighborhood.

The official theme of these year's National Nursing Home Week is "Team Care." According to the AHCA this theme, "recognizes residents and patients in long term and post-acute care settings, the dedicated staff who care for them, and the value of care planning where everyone 'pitches in' for optimal outcomes."

It is encouraging that "care planning" is incorporated into this year's effort. This planning takes many forms, beginning with efforts to prepare for possible long-term care long before the actual care is needed. As elder law attorneys, we have seen many seniors who are forced to chose between two unwanted options when illness or injury befalls them and they do not have plans in place to provide ideal are.

Lack of Planning & Mistreatment
Unfortunately, there is often a connection to a lack of planning and receiving less than quality services. Of course abuse and neglect can occur anywhere, and so all seniors and their families need to be vigilant about standards anytime that one is receiving aid at a nursing home, assisted living facility, or at-home services.

For example, an elder abuse forum was recently held in Saratoga Springs where advocates from the Weinberg Center for Elder Abuse Prevention discussed how elder abuse remains overlooked far more often than it is caught. The advocate explained how elder abuse is much more than broken bones or pressure sores. Instead, a wide range of physical, financial, and emotional damage can strike seniors with their caregivers do not provide proper treatment.

In honor of National Nursing Home Week, hopefully all New Yorkers take an extra moment to check on the seniors in their lives to ensure they are receiving the basic aid they need to thrive in their golden years.

Most discussions of elder financial exploitation include accusations of unique scams targeted at trusting seniors. As we discussed last week, many wrongdoers try to swindle the elderly community via insurance frauds, home repair schemes, and similar techniques. These are very real dangers that must be guarded against. However, it is a mistake to assume that all scams are committed by random strangers.

The sad reality is that many act of elderly financial exploitation are perpetrated by family members. Because of a senior's propensity to trust their relatives and/or not wish to come forward with suspicions against loved ones, financial crimes committed by friends and family are particularly hard to identify. Experts working on these affairs point out that the vast majority of these situations never result in liability. In other words--wrongdoers often get away with it. The "success" rate of this exploitation is one reason why it continues to be perpetrated time and again. That makes it incumbent on all of us to do everything in our power to check on vulnerable friends and relatives and put plans in minimize the risk of harm.

Fraudulent Deed
Prevention is far better than dealing with exploitation after it has occurred. For example, Courthouse News recently reported on one case where an 80-year old woman was forced to file a civil lawsuit in an attempt to get her house back. According to the documents filed with the court, the senior attempted to pay her 2012 property taxes on the home when, to her surprise, she was told that she was no longer the owner of the property.

Apparently, her adult son was the new owner. The woman does not remember knowingly signing over the deed to the home, but the son claims she did just that over a year ago. The son admits that he did not pay anything for the property. However, he claims that it was given in "compensation" for the fact that two vehicles that he owned were "lost" to his other siblings. It is unclear from the report exactly how the other sibling's potential debt may have been involved in this scheme.

Sadly, many seniors find themselves in somewhat similar circumstances, losing control over assets to unscrupulous relatives. When professionals are not around to provide oversight to these sorts of transactions and identify problems early on, then complications like this develop. Ideally, this would have been caught before the deed was signed, eliminating the need for a prolonged legal battle just to fix the fraud.

For help ensuring you or a loved one has that professional oversight, throughout New York please get in touch with our elder law attorneys.

On the whole, studies continue to show that seniors citizens are more "trusting" than younger demographics. Sadly, that trust is often exploited by those seeking to scam seniors out of significant sums of money, including retirement savings. These scams take many forms, and each are a reminder for families to be vigilant about the financial well-being of elderly loved ones.

Recently, headlines were made when authorities arrested a couple who are alleged to have bilked seniors out of nearly $6 million in a far-reaching insurance fraud scheme. The pair tricked many different families into purchasing long-term care insurance to provide in-home care to seniors. They collected a mountain of premiums, but refused to provide any of the actual services needed when participants sought use of their claims.

According to various reports, more than 230 seniors purchased insurance policies from the couple. They paid monthly premiums as high as $4,000 for what they thought would ensure them "unlimited in-home, non-medical services." In reality, it bought them nothing.

The plan worked by having the seniors pay for in-home services out-of-pocket, like cooking, cleaning, and other basic chores. The seniors then expected to submit a claim order, and those costs would be reimbursed. But the couple never intended to reimburse anything. They simply took the monthly funds and refused to honor the claim requests.

The husband in the scheme is a former insurance salesman, and so he was familiar with the appropriate ins and out of the industry and ways to put on a convincing front. The pair ran the business under several different names. Authorities believe that the total haul of nearly $6 million was perpetrated in at least six states over a ten year period.

As the daughter of one of the victim's explained, ""It takes a really special narcissism and cruelty to live an opulent lifestyle at the expense of vulnerable, trusting, often physically or mentally fragile senior citizens,"

Trusted Help
What makes this case so tragic is that the seniors hurt usually only discovered the fraud at the exact moment when they needed help the most--usually after a health decline or serious medical event requiring at-home aid.

It is critical for families to rely on the help of trusted professionals experienced in all facets of elder law issues, including procuring secure and reliable long-term care insurance. The attorneys at our firm are available to help families throughout New York on various issues, from estate planning, securing private insurance, and joining the Medicare program.

This week Dr. Nirav R. Shah--the Commissioner of Health for the state--issued a press release summarizing the positive impact of each of the Medicaid reform efforts that have taken place over the last few years. As many are aware, Governor Andrew Cuomo has been aggressive in his efforts to streamline the system, mostly motivated by financial concerns.

The Commissioner used the occasion to paint a positive picture of the New York Medicaid's current situation. He noted how costs for the program are down while quality indicators are receiving good marks. Amazingly, all of this is coming at a time when actual enrollment in Medicaid is increasing. Lowering costs even with steady enrollment is difficult, and so do so while adding to the program is a real achievement. The press release points out that, all told, over $3.2 billion has been saved in New York City alone. That is not a trivial amount, particularly considering trends had been moving in the opposite direction for years.

Interestingly, the Commissioner noted that it was long-term care services which, in the past, were the main drivers of increased Medicaid spending. But the Medicaid Redesign Team has been able to "bend the cost curve," mostly by shifting resources into less expensive but helpful programs--like at-home care.

The Commissioner's press release also discussed the "Managed Long-Term Care" (MLTC) Program. This slate of projects applied to those on Medicaid who are concurrently enrolled in Medicare (the senior health insurance program). The purpose of MLTC is to provide more cost-effective long-term care. Some worry about the quality of care provided via the MLTC, but Commissioner Shah argues that quality indicators thus far are encouraging, with the vast majority of seniors showing no problems following a switch into the MLTC program as compared to the old system.

This is important considering changing demographics demonstrate that many more New York seniors will likely need expensive nursing home care in the coming years. This will result in more seniors relying on Medicaid for assistance. Our NY elder law attorneys work with families on just that issue.

All of these indicators are good news for New York residents. Efficient but quality public healthcare services are of vital importance to communities throughout the state. Medicaid will only grow in importance in the next few decades. For aid understanding how the qualifications process works, whether assets can be saved from being "spent down," and more, please get in touch without our NY senior care lawyers.

The Post-Star recently published a story with the provocative headline: "Old Age is Coming, and We Are Not Ready."

The article touches on some practical issues in New York state that have often been discussed in the wake of the national demographic shift that is already underway. As most know, the population is aging. But far fewer give serious consideration to what these means for those seniors (and society as a whole). The coming of old age has two main questions: (1) Do we have the appropriate quantity of services to provide the care necessary for all seniors in need in future years? (2) If not, how are we going to come up with the resources to acquire those services?

Minimal Senior Care Services
The story notes that about ten thousand Baby Boomers turn 65 and reach the traditional retirement age each and every day. In the New York state counties of Washington and Warren, those over 65 account for about one-third of the entire population. The trends are similar throughout the state and country.

Many of those seniors will eventually need extra care for daily tasks, perhaps including nursing home stays. But do we have enough beds in nursing facilities to account for the change? Right now, most experts on the issue do not believe that there is anywhere near sufficient supply to meet the coming demand. This is fueling a burst in private investment in elder care resources (like nursing homes) in New York. Nationwide the long-term care industry grew by 31% over the last five years--the trend is expected to continue in the next five.

But many worry that there still may be problems in the future. That is because not only is the Baby Boomer generation far larger than the generations before and after it, but with advances in medicine, that generation is living longer. In the not-too-distant past, retiring at age 65 often only came with a few years of retirement, on average. But today, both men and women live over 75 years on average, with many living much longer. While longevity is a good thing, it comes with clear concerns about supply of care for seniors and finances to pay for that care.

The bottom line: It remains unclear how public bodies will respond to the looming senior care challenges. That makes it in every individual's best interest to take matters into their own hands and ensure plans are in place to provide for their own well-being no matter what the future holds. That may include contacting an elder law attorney and ensuring access to NY Medicaid services.