New York Elder Law Attorney Blog

Earlier this year a featured article in Atlanta Magazine offered a uniquely detailed and accurate portrait of what it is really like to help an ailing parent or loved one as their heath deteriorates. Entitled, "The Long Goodbye," the article shares the author's own story of heartbreak, worry, stress, financial loss, and confusion while caring for his ailing father. Each New York elder law attorney at our firm understands that it is often helpful to hear real, individual stories about the aging and caregiving process. Discussing numbers--assets saved, taxes avoided--is necessary, but at the end of the day this process is very much about emotions and family values.

The author explains that he thought his father was going to die in 2001. The elderly man had fallen while trying to get the mail, hitting his head hard on the ground and temporarily losing consciousness. The man then skinned his knees as he crawled back up his driveway to the front door of his house. It was that incident that prompted his family to take him to the hospital where he was diagnosed with a deteriorating spine. Not only that, but doctors also found prostate cancer. A risky operation was undertaken, and the family was warned that the man was likely in his final days.

However, he was not actually in his final days.

Similar to the experiences of many local community members, the elderly man persisted. For the next eleven years he was shuttled from care facilities, hospices, and other locations as those involved struggled to find the best fit for him. Our New York elder law attorneys have worked with many clients who have similarly been confused as to what long-term care options are best for their loved one.

The eleven years of care took its toll on the family finances. The author explained, "Daddy's long goodbye has drained his retirement income and life savings of more than $300,000. Where's the money gone? Assisted living, mostly. Of course, that amount doesn't account for his medical bills, most of which have been paid by Medicare and insurance policies that were part of his retirement."

The author admits that he and his sister were completely unprepared to deal with their father's deterioration. They were not familiar with long-term planning options, had not spoken with an elder law attorney, and did not know where to begin to get him the care he needed. The author warned others that while it may not be comfortable to talk about, the benefits of figuring some of these details out ahead of time is absolutely essential.

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The vast majority of residents receiving long-term care in nursing homes in our area participate in the New York Medicaid program. The program is a crucial state-federal effort that ensures seniors and the disabled have the access to life-saving, day-to-day care that they need. Recently, several influential federal officials have begun asking questions about one crucial aspect of the program: drug prescriptions. Essentially, the officials are focusing attention on the potentially excessive practices of some doctors in the program. The officials want to know if the alarmingly large amounts of drug prescriptions by some medical professionals are necessary (and safe) for the consumers who receive them.

Financial concerns are obviously involved in this particular investigation, but our New York Medicaid attorneys understand that this oversight can also be an important way to ensure that quality of care standards are met at these homes. For example, as discussed in a Pro Publica story published yesterday, many states, including New York, are being pressured to crack down on doctors who prescribe massive amounts of potentially dangerous drugs to seniors. The effort is being led by Senator Chuck Grassley who sent letters to three dozen states asking about efforts underway to investigate physicians who prescribed antipsychotic drugs and anti-anxiety painkillers with seemingly reckless abandon.

In the elder law context, these drugs have very real consequences for seniors. Nursing homes have long been known to provide antipsychotic medicine to residents for "off label" purposes in an effort to make the residents easier to control. However, recent studies have found that not only does this practice deprive seniors of the ability to be fully engaged in the world around them, but overmedication can be downright dangerous. There is actually a black box warning on antipsychotic medications explaining that use by a patient with dementia can lead to an increased risk of death. Yet, dementia patients still receive this medication in nursing homes across our area each day.

Now the Senator is hoping to crack down on the doctors who overprescribe these drugs. Unfortunately, a lot of work still needs to be done in this regard as most doctors face few punishments for prescribing large amounts of medications, even when they are unable to show that the prescription rates were necessary. Some doctors issued tens of thousands of prescriptions each year. For example, one physician wrote nearly 19,000 prescriptions for the antipsychotic drug Seroquel last year alone, totaling almost nine an hour for every hour of every workday.

In one bit of positive news, over the past few years New York was actually praised for cutting down on some of the most abusive practices. A few of the highest-prescribing physicians in our state who could not explain their actions have been kicked out of the Medicaid program--saving taxpayer dollars while keeping seniors safer.

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Yet another company, Northwestern Mutual, has recently issued a "Cost of Long-Term Care" study. Of course, the results indicate that the actual cost depends on a range of factors including what part of the country one lives, whether an at-home aide is hired, or whether one moves into a skilled nursing facility. As any New York elder law attorney can attest, our area is always at the very top of the list when it comes to long-term care costs. It is for that reason that it is particularly incumbent upon area resident to meet with an elder law attorney to plan ahead before the costs actually need to be paid. It is simply impossible for most families to bear the financial burden of this care on their own.

This latest research effort from Northwestern Mutual involved surveys from 6,000 different sources, including a mix of assisted living facilities, home health care organizations, and nursing homes. The researchers found that the hourly rate for home healthcare workers was anywhere from $33 per hour to $15 per hour. New York assistance was near the highest of the group.

Assisted living facilities had rates anywhere from $1,500 a month to just shy of $7,000 per month. As with home health care workers, our area has particularly expensive assisted living facility prices. In addition, it is often difficult to even get into one of these facilities, as many of the best have long waiting lists of folks hoping to get a spot when there is an opening.

Nursing home care is particularly expensive, both in New York and throughout the country. The average cost throughout the country is around $90,000 a year. However, rates in our area can rise to more than double that amount, usually over $10,000 a month. It is important to note that these costs do not even include related expenses like use of medical equipment, transportation, and medicine.

The research project also determined that right now there is a 66% chance that a senior over the age of 65 will eventually need long-term care. Similar surveys have identified that rate as even higher. Overall, that means that for most residents the question is not a matter of if they will need this care but when. With odds like those it is simply common sense to take the time to plan for the care ahead of time. Local residents who conduct even basic New York elder care planning can save hundreds of thousands of dollars in assets that otherwise would vanish had the preparations not be taken.

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The focus of most New York elder care planning discussions naturally revolves around the needs of seniors. Are they receiving proper nutrition? Do their caregivers timely attend to their dressing, bathing, and washroom needs? Do they remain connected to the community with opportunities to use their unique skills and abilities? Our New York elder law attorneys know that for far too many seniors, even these basic needs remain unmet. The problem of elder neglect and abuse is troubling, and it will likely become more of a concern in the coming years as the population ages and the total number of seniors in need of extra help skyrockets.

However, a holistic approach to senior care requires not just consideration of the senior's needs but also understanding of the effects on senior caregivers. A CNN Living article this week examined the way that helping an elder resident impacts adult family members. The story of one woman was shared who took her 72-year old father out of a nursing home out of concerns for his well-being. Instead she moved him into her on own two bedroom apartment. The woman admits that she put her life on hold, because the obligations of working full-time while helping her father was overwhelming. She was often required to miss work to take him to a wide range of appointments with medical professionals. In addition, she used her lunch breaks to ensure he took his medications and made it to his dialysis appointments. She confesses, "It was like 'oh my, what did I get myself into?' Sometimes I would just go into the bathroom and cry."

Her situation is not unique as a new "Stress in America" survey from the American Psychological Association found that at least 55% of senior caregivers feel overwhelmed by the task. Not only did the caregivers report higher levels of personal stress, but they were also found to be in poorer health themselves. Caregivers were more likely to engage in unhealthy behaviors in an attempt to alleviate the stress.

As any elder law attorney or others involved is long-term care planning can attest, the quality of care received by a senior is directly dependent on the work and well being of their caregivers. If caregivers are stressed or unhealthy, there will likely be repercussions for the elder. That is why psychological experts suggest that families be realistic when conducting long-term care planning or deciding what to do when a senior is in need. The psychologist leading the latest stress report explained, "It's impossible to be all things to everyone, so what we have to do is have honest straight talk with ourselves about how much we can handle and when we seek help from others."

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Our New York elder law estate planning lawyers understand that handling long-term planning issues can be particularly delicate when there are second marriages involved. However, it is in these situations, with blended families, when this sort of planning is absolutely critical. Many adult children have natural concern when their parent remarries. Obviously there are inheritance planning issues, and it is vital that seniors who remarry make their wishes very clear about who they'd like to receive what. Failure to do so opens the door to strong disagreement and infighting between those involved. The family glue can come undone even among blood relatives, and there are often even less ties keeping fights in check when blended families are involved.

Beyond inheritance issues, local families should also take note of the New York elder law concerns which are implicated by second marriages and blended families. Decisions about naming a Health Care Proxy and Power of Attorney in the event of disability can present some disagreement when seniors remarry.

An article this weekend in the Laurel Leader-Call referred to another issue regarding the long-term care planning problem in the context of second marriages. The story discussed two seniors who met at an assisted living facility, fell in love, and married. Eventually one of the partners began a physical and mental decline and needed to be moved to a nursing home. The couple did not realize that Medicaid could have been applied for to help support those nursing home costs. If the partner whose health deteriorated passes away, their life savings may be entirely exhausted in providing for the long-term care. As a result, the surviving spouse is often left in dire straits when his or her own health deteriorates and they have a need for skilled nursing care. What often happens is that adult children are forced to scramble in crisis mode to figure out how to pay for the care the elder needs. A range of issues are present when those adult children are step-children who may not have as close a connection with the senior.

Blended families and second marriages raise a variety of concerns that should be accounted for by prudent families. Both estate planning and elder law issues are raised. The issues are often complex, and so professional help is always advisable. It is particularly important to ensure that the professional which is sought out has experience in both areas: elder law and estate planning. Failure to account for disability and long-term care issues may make inheritance and tax planning ineffective (and vice versa). All parts of the planning must work together to ensure that they are effective at the moment when they are needed.

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Laws change. Elder law and estate planning strategies change. But the basic principles surrounding inheritance planning, disability planning, and preparing for one's golden years have been around for centuries. In a soon to be released book from Harvard University Press entitled Someday All of This Will be Yours: A History of Inheritance and Old Age, author Dick Hartog takes a look at some of those timeless principles that have involved elder law and estate planning over the years.

A recent book review summarized the text by noting that Hartog (a legal historian) examines how "ordinary men and woman arranged for their own care as they aged, and then how their alleged caretakers attempted to use the law to make good on these arrangements." Of course our New York elder law attorneys are immediately drawn to these sorts of topics as helping local families make these arrangements is a large part of our practice today. The new Hartog book looks at dozens of elder law cases over the years and "closely, carefully, and painstakingly examines these cases for what they show about changing patterns in care for the elderly, parent-child relations, [and] the tensions between family and commodification." The book discusses how these issues have changed or not changed over the years.

While the principles have likely remained unchanged the strategies to carry out wishes has undoubtedly shifted in recent decades. For example, Hartog discusses how in many circumstances elderly parents convinced children to provide the caretaking they needed with promises (sometimes legally enforceable, sometimes not) that family assets would be passed to them so long as the care was satisfactory. He explains that the core inducement of providing such care was the understanding that a family farm, home, bank account, or other asset would be passed to the child in exchange for the child providing the help that the elder needed with tasks like cooking, cleaning, nursing, or even just companionship. Hartog also discusses how elder law attorneys have gotten involved over the years to help seniors, particularly when those previous promises are not fulfilled.

As the book review author noted, elder law is an area that is finally coming into its own. While our New York elder law attorneys have been working on these issues for years, we appreciate that that it is still difficult for many families to find professionals with specific experience in the wide range of issues related to planning for seniors. Fortunately, most law schools now have at least one elder law course. Hopefully awareness of these issues will continue to grow so that more families take the time to plan in ways that take full advantage of the current available legal tools.

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Confusion often reigns when one learns that a family member will likely need long-term skilled care. Finances are always an issue. With the average stay in a local nursing home running $11,000 per month, our New York elder law attorneys are acutely familiar with the financial challenges facing local families at these times. Few can afford to pay those costs out of pocket. Without long-term care insurance (expensive in its own right), most families instead turn to Medicare and Medicaid for support.

Many seniors on Medicare get understandably confused when trying to determine what long-term care is provided by the program. The short answer is: very little. The Centers for Medicare and Medicaid Services have produced a handbook entitled Medicare Coverage of Skilled Nursing Facility Care which is a good starting point for those hoping to learn more. In general, the takeaway is that Medicare will only pay for certain skilled nursing stays and never for those staying longer than 100 days. The first 20 days of qualifying care are covered completely, while anything more (up to 100 days) often requires some sort of copayment. To even qualify for that care a resident must have a qualifying hospital stay, need the care immediately after the hospital stay, and meet a few other requirements.

Conversely, Medicaid is the joint state and federal program that provides the most support for extended nursing home stays. That is why on the elder law side of our practice our New York Medicaid attorneys work closely with local seniors to help them apply for the program and save their assets from being consumed in the qualification process. Unlike Medicare, Medicaid is an income-based program, meaning that local seniors will have to show specific financial need before receiving the help. The application process which takes all of this into account has complex asset and transfer rules. Because it is a joint state and federal program, the qualification process is different in each state.

There are actually two forms of Medicaid: Community and Chronic Care. As the name implies, Community Medicaid is much different in that it provides certain resources for individuals who wish to remain at home in their community. When that is no longer an option and close nursing home care is needed, then Chronic Care Medicaid comes into play. It is this form of Medicaid that has a "five year look back" period for assets and transfers. That means that if assets--a home, stocks, savings accounts--were handed over to another within that period, the value of those transfers may take the form of a penalty period where Medicaid services will not be provided. However, there are various strategies that can be employed to protect against the loss of all of one's assets while qualifying for Medicaid. This is true even if one is on the nursing home doorstep. Professionals in the area will be able to explain those strategies and decide on the right course in your case.

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Yesterday our New York elder law attorney Bonnie Kraham Esq., had another article published in the Times Herald-Record. In the piece Attorney Kraham explains how it is common sense for middle class families to work to protect their assets from long-term care costs. The basic idea behind asset protection for seniors is simple: take advantage of legal tools so that assets can be passed down to children instead of lost to pay for long-term care. The wealthiest families have been using these strategies for decades, but more and more middle class families are coming to appreciate the benefits of protecting assets that have often taken a lifetime to accumulate.

As Attorney Kraham explains in the story, long-term care costs are high everywhere, but they are particularly significant in New York--roughly averaging about $11,000 per month. At the end of the day there are only three ways to pay for those costs: (1) out of one's own assets; (2) via expensive long-term care insurance; (3) through Medicaid. Few community members can afford long-term care insurance and most only have personal assets to pay for these costs for a limited time. That is why our New York elder law attorneys work with families by using available tools under the law to protect assets in these situations. The goal is to help families receive Medicaid assistance without losing their personal assets in the process.

To accomplish this goal Medicaid Asset Protection Trusts (MAPTs) are often created. Assets are then moved into the trust. Those assets can be protected from being taken to pay for long-term care costs. Government officials specifically designed the system to allow for such planning. For example, there is a five year "look back period" during which the government will evaluate to see if certain asset transfers were made. Those transfers will trigger a penalty period whereby Medicaid payments will be withheld. However, if planning is done beyond that five year window, then all assets can be protected without any such penalty.

A few have questioned the morality of asset protection. It is important to keep these New York elder law asset protection strategies in context. Asset protection measures have been used in various capacities for centuries. Estate taxes are routinely guarded against, and corporations shield personal assets from private ones. It is not be surprising or unfair for middle-class families to use the same strategies to pass on the fruit of their labor to the next generation.

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Making the decision to place a loved one in a nursing home is no routine matter. Emotions run deep during this time, when families struggle to balance the senior's need for close care and safety with their concerns about the quality of life available in these assisted-living facilities. Our New York elder law estate planning attorneys have helped many families with this process. We appreciate that there are usually two big questions that come up: (1) What is the best facility for our loved one? and (2) How are we going to pay for it?

In answering the latter question, New York elder law attorneys will explain that the costs can either be paid out of pocket, via use of private long-term care insurance, or through the New York Medicaid system. The former question is a bit more challenging, because so much subjectivity is involved. The answer for each family is different. The exact type of care needed, proximity to loved ones, and similar details need to be considered when choosing which nursing home is best. Of course, as a general matter, every family will want to ensure that the nursing home they chose is one free of chronic neglect, mistreatment, and abuse. Many elder care advocates have explained that when it comes to safety measures, study after study has found that nonprofit nursing homes outperform for-profit facilities. One long-term care doctor explained, "Most studies show that nonprofits do a better job of caring for patients, but we're not sure why that happens." This is an important consideration for families deciding where to send their loved one.

A post this week in the New Old Age blog from the New York Times recently discussed another interesting comparison between for-profit and nonprofit homes: the employees are happiest at nonprofit nursing homes. This may be part of the reason why care at these facilities is superior. At the end of the day, the quality of life for those in these facilities is dependent on the work performed by the hands-on caregivers. Therefore, how those caregivers perceive their job is likely to play a key role in their day-to-day actions. The nonprofit employees were happier overall for a variety of reasons: their ability to help set policy, more supportive managers, and availability of adequate resources.

One corollary is that staff turnover at nonprofit homes is much lower than at for-profit facilities. It is not hard to see how consistency in the workforce helps breed experience and better overall care. Long serving nurses and nurse's assistants can gain familiarity with each resident and are better able to understand their quirks, notice problems, and respond quickly to their needs.

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Many writers have taken to calling the upcoming wave of baby boomer retirements as the "silver tsunami." Like real tsunamis, the demographic shift is expected to have many ripple effects in communities across the country. Each New York elder law attorney at our firm has seen first-hand the challenges faced by many in our area when trying to figure out where they will receive long-term senior care and how they will pay for it. These issues are common to all local families who have loved ones about to leave the work force to enjoy time in their golden years.

However, some senior community members have even more unique concerns.

The Associated Press published an interesting article this week discussing the struggles of senior GLBT community members. Public opinion data consistently shows that the younger generation is much more open and supportive of their gay, lesbian, bisexual, and transgendered community members. Older Americans are less approving. That is leading many gay seniors to wonder how they might be treated if they end up in a traditional nursing home or long-term care facility. One expert summarized that many of these "seniors fear discrimination, disrespect or worse by health care workers and residents of elder housing facilities, ultimately leading many back into the closet after years of being open." In addition, GLBT seniors are much less likely to have biological family members to help them through this time of their life. Estrangement and childlessness are more common for gay seniors, making them more dependent on outside services.

These concerns affect a sizeable minority of local residents. Of the 77 million baby boomers expected to retire this year alone, more than 1.5 million are gay, according to the New York group Services and Advocacy for GLBT Elders (SAGE). These concerns have led many to call for an increase in gay-friendly senior housing options. Our New York elder law estate planning attorneys recognize the unique needs of this community, having long helped GLBT residents with their inheritance planning, tax considerations, and New York elder care planning.

Fortunately, some developers are taking the opportunity to fill the need for senior care options for the community. A new 52-unit GLBT-friendly affordable housing unit is breaking ground in Philadelphia this year. The $17 million building is set to open in 2013. A similar project is also in the works for New York City, though the project still has many hoops to jump through. The only finished facility of this sort is in Los Angeles. That 104 unit facility is already filled, with a 200 person waiting list. Private retirement facilities for gay seniors already exist, but these options are often financially out-of-reach for many residents. The lower cost options will hopefully fill the void and provide vital services for this community.

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Elder financial abuse is fast becoming a national crisis. That is the message that a New York geriatrician and social scientist is spreading after conducting extensive scientific investigations into the extent of fraud and financial exploitation among local seniors. The doctor is encouraging friends, family members, caregivers, New York elder law attorneys, and others to keep a close eye out for the signs that this abuse might be occurring among seniors that they know.

As reported in the Centre Daily Times, the doctor's latest work suggests that literally millions of seniors are victimized financially each and every year. Yet only a fraction of the instances of abuse ever come to the attention of authorities--only one in forty four, according to the report. In even fewer cases are the wrongdoers held accountable for their conduct. Previous work by this same team of researchers also found that those seniors who had been abused financially saw similar damaging effects on their physical well-being. The groundbreaking work revealed that mortality rates of elderly victims of financial abuse were significantly higher than for those who had not been abused. Suffice to say, this mistreatment has profound effects on the lives of victims and all efforts to limit the problem must be taken.

Yet, there is a long way to go before the mistreatment is stamped out. According to the latest research at least 2.5 million seniors are victims of financial abuse each and every year. Even then, that number may be a significant understatement. For one thing, it was reached mostly via self-reporting. Many seniors might hide their situation out of fear or embarrassment. Additionally, the research team noted that seniors who were suffering from a severe rate of mental decline were not polled in the survey. Yet it is that very group which is at the highest risk of being victimized by unscrupulous individuals willing to take advantage of them for personal financial gain.

Visiting a New York elder law attorney before a loved one with cognitive mental diseases, like Alzheimer's, loses the ability to communicate is essential. The professional will be able to provide an extra set of eyes on the senior's books which may help catch irregularities or signs of financial abuse. Beyond that, having an elder law estate plan put in place will help keep the senior's wishes fulfilled, even if they lose their mental capacities. Substitute decision-making documents will also be crafted to provide for the best interests of the elder as the disease progresses. These include creation of a Power of Attorney and Health Care Proxy. All of this will help avoid costly, timely, and stressful guardianship proceedings through the court system.

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The New York Times published a blog post last week on a new effort called the "Conversation Project" seeking to make long-term care planning a kitchen-table issue. The project, spearheaded by former journalist and Pulitzer Prize winner Ellen Goodman, is the first step in a comprehensive effort to ensure that long-term caregiving is considered when all local, state, and federal policy and financial decisions are made. Ms. Goodman became involved in the project while helping her 92-year old mother in her later years. Being 70 years old herself, the journalist became incredibly frustrated with the confusing nature of the senior caregiving process and the lack of advocacy for those involved. Ms. Goodman was actually on Medicaid for a few years at the same time as her mother, a situation that our New York Medicaid lawyers know is becoming more and more common.

Many details of the Conversation Project are still being developed. At this point Ms. Goodman is leading a webcast in late January, has an online forum, and has an article being published in the upcoming Harvard Business Review's "12 Audacious Ideas" issue. The Institute for Healthcare Improvement in Cambridge is also acting as an unofficial sponsor of the project in its early stages.

In discussing the project, Ms. Goodman explains that the beginning of the advocacy effort involves massive communication. She noted, "Everyone has a story. We need to share stories of the good deaths and bad deaths of people we loved." She explained that more community members must demand access and information to help them ensure their story is not one of pain and unhappiness. Of course, every New York elder law attorney at our firm is familiar with how prior preparation plays a huge role in the quality of life experienced by seniors in their later years.

The Conversation Project is hoping to combine with other efforts which are pursuing similar goals. For example, a former head of the AARP has launched the Coalition to Transform Advanced Care (C-TAC). C-TAC states its mission as one to empower long-term care consumers and deliver policy changes for the benefits of an aging population.

Many of the activists involved in these efforts are surprised that there has not been more community outrage based on the often inadequate care provided to many seniors. They argue that Medicare and Medicaid have not kept up with the changing dynamics of the elderly population. One advocate noted that these days seniors "live too long and die too slowly, at enormous financial and emotional cost to themselves and their families."

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New York City is renowned for its lack of sufficient senior living options. New York elder law attorneys know that competition is often intense for available spots in some of the better long-term care facilities. That competition will only grow more intense in the coming years as the number of available rooms drop and demand from the senior community increases. If more facilities aren't built, it will likely become even more difficult to access the highest quality elder living options, particular those that prioritize senior quality of life. As the chief executive of the International Council on Active Aging noted, "What used to work is no longer an option. We're moving from being a care society to one where we take self-responsibility."

Many more are growing aware of the looming housing crisis and are working to expand New York elder care options. For example, on Tuesday the Wall Street Journal reported on a new, ground-breaking nursing home that is set to be constructed on the city's Upper West Side. Those involved in the project explained that a 24-story Jewish Home Lifecare nursing home will be built at 97th Street between Amsterdam and Columbus. It will accommodate 288 total residents.

Those involved in the project explain that the new facility is intended to offer original designs and unique modes of staffing. It seeks to do away with the old-fashioned (and often despised) institutional approach with shared rooms and long corridors. Instead, the facility is being built to feel more like regular homes with private rooms clustered in small, 12-room pods. The staffing will also be different than the norm. Under the current plan the same two nursing assistance will be assigned to each apartment cluster. Those caregivers will go beyond tasks done in regular homes and instead also help with cooking, light housekeeping, and the facilitation of recreational activities.

This pioneering project has been in the works for years. Those involved have long wanted to build a facility with this new model, however it has been a challenge to marshal the appropriate resources to actually move ahead with the space-intensive design in the high-rise environment. However, things now appear to be in green-light mode. The $250 million project is set to break ground in February of 2013 with move-ins slated for the Spring of 2017. One New York elder law attorney explained that this project is clearly the area's most ambitious new senior housing development. He noted that is comes at a precipitous time considering the need for such spaces to accommodate aging Baby Boomers.

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Local seniors obtain peace of mind knowing that they will be able to receive late-in-life care in an ideal setting and that the care will be of top quality. These simple goals should not be out of reach for any elder community member. However each New York elder law attorney at our firm knows that many seniors will be forced to deal with less than adequate care, often in institutional settings where they would rather not live.

Part of the problem is that many local residents will not have visited with a New York elder law professional ahead of time to plan for this time in life. Staying in one's home while aging usually requires advance planning. However, it is not enough to merely have the aid of a home care worker--one must ensure that the worker is actually providing an appropriate level of care. A recent article from Aging Parents explained that there has been a shortage of quality home care workers. One of the problems, argues the author, is the fact that for a period these workers were exempt from minimum wage laws. When Congress passed minimum rights legislation, all home care workers were lumped into the category of exempt employees who acted as "companions." This was the case even for workers who engaged in a wide range of physical labor helping seniors bathe, dress, use the facilities, walk, get exercise, and eat properly. Of course, it seems intuitively unfair for these workers to be forced to live in dire poverty at incredibly low wages and no overtime pay.

Fortunately, the legal error was recently corrected. The author suggests that part of the reason the law took so long to change was that many of the individuals who fill these roles have few advocates, often including women and those who are not native English speakers. Also, as a result of the prolonged period of abysmal pay, advocates are worried that there is a shortage of well-trained, capable home health care workers. The need for these workers is expected to skyrocket in the coming decades.

The shortage of quality caregivers makes it important for local residents to conduct proper research when deciding on an appropriate home care provider for their loved one. A New York elder care plan that allows for home care is of little value if that home care worker is inadequate. Therefore, most advocates recommend going through a qualified agency to find these assistants. Most agencies are required to perform multi-state background checks, screen for drug use, and require references. The risk of abuse or theft is always much higher when home care workers are unsupervised and unaccountable.

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Each New York elder law attorney at our firm understands that maximizing the quality of life for local seniors requires both proper individual planning and common sense elder law policy proposals at the local, state, and federal levels. On the planning side, all local residents should visit with a New York elder care lawyer to prepare for disability, save taxes from Medicaid costs, and deal with similar issues. When it comes to policy, it is helpful to stay up to date with changes that are being proposed which may affect the lives of seniors. One of the key governmental bodies related to these issues is the U.S. Special Committee on Aging. This Senate committee has been at the center of all important federal elder law issues over the past half century.

Last week the National Academy of Elder Law Attorneys (NAELA) issued a special proclamation honoring the 50th Anniversary of the U.S. Special Committee on Aging. NAELA, a nationwide group of elder law attorneys, also co-sponsored an event in Washington D.C. honoring the committee's achievements.

The Special Committee was first created in 1961 as a central national clearinghouse to discuss and deliberate on a wide range of issues that affect senior citizens. Over the years the committee has been involved in any number of senior issues, from health care problems and elder financial exploitation to retirement security and nursing home abuse. In recent years the Special Committee on Aging has led the way in passage of the Elder Justice Act, Older Americans Act, and a wide range of issues seeking to improve the care at long-term skilled nursing facilities. Last year the committee brought national attention to senior housing issues during its hearing entitled "Continuing Care, Retirement Communities: Secure Retirement or Risky Investment?" In recent years the Committee served as the center of other important debates such as during the hearings "Exploitation of Seniors: America's Ailing Guardianship System" and "Sound Policy, Smart Solutions: Saving Money in Medicaid."

The overall mission of all those public officials on the committee and the advocates who testify before it is improving the quality of life for older Americans. The committee's mission has taken on even greater importance in recent years as a larger and larger percentage of Americans become seniors with the aging of the Baby Boomer generation. Many advocates have warned that housing options for seniors and access to appropriate healthcare will gain even more importance nationwide in the coming years. The U.S. Special Committee on Aging will undoubtedly play a central role in understanding those issues and figuring out possible policy solutions.

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