July 21, 2014

Elder Care Issue: Drug Abuse in Nursing Homes

This summer, one nursing home settled a massive class action suit against the facility for using powerful and dangerous drugs on its residents without their informed consent or consent from family members. One member of the suit was a daughter whose mother entered the facility for eighteen days for physical therapy for a broken pelvis. The nursing home had given her heavy medication, including many dangerous antipsychotics, and within a matter of weeks she was dead. This class action lawsuit was the first of its kind in the country, and with a growing issue of drug abuse in nursing homes it will most likely not be the last.

A Growing National Issue

Sadly, this case is not an isolated event. Researchers estimate that as many as one in five elderly patients in nursing homes are given powerful antipsychotics and other drugs that are wholly unnecessary. This growing trend comes from a variety of sources, including but not limited to inadequate training of staff, understaffing of facilities, and aggressive selling by pharmaceutical companies. The Center for Medicare Advocacy has been quoted as saying that "The misuse of antipsychotic drugs as chemical restraints is one of the most common and long-standing, but preventable, practices causing serious harm to nursing home residents today."

Antipsychotic drugs are meant to help people with severe mental illness such as schizophrenia or bipolar disorder. The FDA specifically states on the boxes of these medications that they are not intended for the elderly population. Using these drugs on seniors can cause agitation, anxiety, confusion, disorientation, or even death.

Kickbacks for Doctors and Being Kept in the Dark

Multiple pharmaceutical companies, including giants Johnson & Johnson as well as Omnicare, have been fined billions of dollars for marketing drugs to nursing homes that were not approved by the FDA or deemed suitable for the elderly. Additionally, doctors were given kickbacks for prescribing these medications to their patients in nursing homes. Considering that so few doctors ever actually visit the facilities or are there so little, they do not see or care about the effects of the drugs on their patients.

Another reason for this growing problem is the law requiring informed consent is not being followed. Neither the patient nor their families are being told about the use of these drugs in the nursing homes. One reason is because of the lack of training for nursing assistants. With only seventy hours required for training, these staffers typically do not know that consent is required before administering these drugs. Because nursing homes are chronically undertrained and understaffed, so-called behavior problems can arise with the patients. The pharmaceutical companies market these drugs to nursing homes as a way to deal with that issue.

Searching for a Better Way

Thankfully, more nursing homes are now looking for a way to combat the issue of overmedicating its patients. One way nursing homes are dealing with this problem is by providing additional training for staff - both in requirements for federal regulations as well as how to deal with problem patients. Another way this issue is being addressed is by public outreach and advocacy. If more family members of nursing home patients know about the issue they can inquire with the nursing home about their loved one's care. And now that one lawsuit has been successfully brought against a nursing home for drug abuse, hopefully it will serve as a deterrent to other facilities that misuse the same practice.

July 15, 2014

More States Showing Support for Uniform Adult Guardianship Act

The Massachusetts Senate just passed through a bill adopting the model set of rules for the Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act (UAGPPJA). The bill now goes to the state House of Representatives, and if it is passed then Massachusetts will be the thirty-ninth state in the country to adopt this act. This model set of rules makes it easier for family caregivers to provide care for their loved ones across state lines.

Guardianship

A court will appoint a guardian to a person when someone is incapable of managing personal decisions or property. The guardian then makes decisions about personal property, medical choices, living arrangements, and financial issues. Appointing a guardian in court can be difficult and time consuming; however, they are a great way to prevent elder abuse, neglect, or exploitation.

If an elderly person is in need of a guardian in one state and the family is located in another, jurisdictional issues can arise. The tangles of figuring out which court gets say over what can take time and money to sort out. That is why many states have enacted or introduced the UAGPPJA in order to simplify the process of determining jurisdiction for guardianship.

What is the UAGPPJA?

The UAGPPJA is an act that addresses the issue of jurisdiction over adult guardianships, conservatorships and other protective proceedings, providing a mechanism for resolving multi-state jurisdictional disputes. The goal is that only one state will have jurisdiction at any one time. The act designates the individual's home state as primary jurisdiction, followed by a state that the individual has a significant connection, which then gives the court a clear process for determining which state has jurisdiction to appoint a guardianship or conservatorship if there is a conflict.

By enacting this set of rules, many states have saved time and money for guardians and conservators of the elderly, which in turn allows them to make decisions for their loved ones more quickly and with less hassle. The UAGPPJA provides a set of rules that explain how one court can transfer the guardianship procedure to another state as well as how to accept the transfer in a second state. This act helps to facilitate better enforcement of guardianship proceedings as well as protective orders for seniors that come in from other states.

UAGPPJA Progress

If Massachusetts passes the act in the House of Representatives, it will become the thirty-ninth state to enact the legislation. Already this year Mississippi and New York passed the act, and in addition to Massachusetts the law has been introduced in California, Michigan, Rhode Island, and the U.S. Virgin Islands. As of July, the only states in the nation that have not either passed or introduced this legislation are Texas, Louisiana, Kansas, Florida, Georgia, North Carolina, Wisconsin, and New Hampshire. As more states enact this law, it will become even easier to provide guardianship and care for our elderly loved ones nationwide.

July 11, 2014

New Estate Planning Option: Longevity Insurance

One of the most important parts of elder care is ensuring that you or your loved one is financially secure in later years. A wide variety of financial tools and plans are available to help structure this care for seniors, but as of July a new tool has been introduced for retirement planning that has not been widely available before - longevity insurance.

What is Longevity Insurance?
Longevity insurance is also known as a deferred-income annuity. You pay a lump sum of money as a premium to an insurer in exchange for a lifelong stream of income that begins years later, even as late as your 70s or 80s. Before July, longevity insurance could not be widely used in 401(k) or other individual retirement plans because those types of plans require that the holder start making withdrawals at age 70½. The rules have now been changed that allow workers to purchase these annuities if they use a portion of their retirement money and begin to make withdrawals by age 85.

Why is Longevity Insurance Available Now?
The federal government announced these changes to longevity insurance as part of its plan to broaden the options available to seniors and provide Americans with more financial security in retirement. The administration believes that this will help seniors plan for retirement and ensure that there is a constant stream of income available for as long as they live.

Before July, less than twenty percent of all 401(k) retirement plans offered any type of deferred-income annuity, and few people ever elected to exercise the option. The administration is hoping that by changing the rules more people will take advantage of this retirement tool. The Treasury department has stated that workers will have some flexibility in choosing their longevity insurance plan. If you purchase an annuity later in life you can start making withdrawals later, as well.

Specifics of Longevity Insurance Plans
In order to partake in the new option of longevity insurance a worker can use no more than twenty-five percent of their retirement balance or $125,000 to purchase the plan, whichever is less. If you accidentally exceed the limit for purchasing a plan you will be allowed to correct the error without penalty. In addition, the annuity plan must be relatively basic and cannot come with many of the special features that insurance providers sell with other plans. However, one feature that will be allowed is a rider that guarantees the beneficiaries of the account the original premium paid, minus any distributions. Another option that is available is to have the longevity insurance continue to pay out to a beneficiary after the original holder's death.

The reason for the limited options on the longevity insurance plans is that the government does not want it to be too difficult to compare the prices of the plans. Having fewer options also decreases the chance of insurers selling plans with so many extras that the income stream is greatly reduced. However, by allowing a couple of extra options on the annuity plans participants can purchase longevity insurance with some level of guarantee on the payout and the security of knowing that they or their loved ones will be taken care of in their senior years.

July 8, 2014

Elder Abuse Shelter Providers to Meet for Conference

Some of the leaders in providing shelters for victims of elder abuse are meeting for the first time at a conference in an effort to combine forces and give more refuge to seniors in need. Eight shelters have formed an alliance that are meeting in suburban Cincinnati to discuss the growing problem of elder abuse as well as ways to better combat the issue. The shelters in the alliance have been participating in monthly conference calls to discuss their programs, and this is the first time that they will all be meeting in person to talk about their elder abuse shelters. They plan on sharing best practices, are bringing in expert guest speakers, and work together to create an even better network of elder abuse shelters.

Elder Abuse and Prevention
Estimates from leading researchers are that at least two million seniors are abused, exploited, and neglected every year in the United States alone. In addition, nearly everyone agrees that many more cases of elder abuse go unreported or undetected. The number of seniors over the age of seventy is expected to more than double to about 64 million people by 2050. Elder abuse occurs most often at the hands of a family member or other people close to the victim.

As a result, elder abuse advocates encourage bank employees, other service providers, neighbors, and anyone else close to someone in their senior years to be alert for signs of physical and mental elder abuse. Prevention training has begun in states like New York to certain groups that see the elderly often like doormen and apartment workers.

Elder Abuse Shelters
The elder abuse shelters are designed as a safe place for victims to receive emergency care, counseling, and legal help for their abuse issues while they stay among their fellow peers in the senior community. The leader of the Weinberg Center for Elder Abuse Prevention that opened in 2005 at New York City's Hebrew Home has found that engaging with victims of elder abuse in an environment where their dignity is a priority and they can be in an established community has been the most effective way to begin the healing process for these victims. Typically, the shelters provide ninety to 120 day programs in the community for free with a range of services aimed at giving the victims of elder abuse a way to resume their lives in a safer location.

The Weinberg Center has helped other nonprofit organizations around the country form their own elder abuse shelters. Most of the shelters outside of New York are operating in Connecticut, Rhode Island, Minnesota, and Ohio but other shelters are opening in various states. Additionally, states and private entities that are interested in opening their own elder abuse shelters were also encouraged to come to the conference in Ohio in order to learn more about the shelter programs. "I felt it was really important that we have conversations, that we create best practices and that we share successes and challenges," the leader of the Weinberg Center said, in order to help the shelter movement grow.

July 3, 2014

Lessons Learned from Casey Kasem's Legacy

Casey Kasem was known mostly for his long and illustrious career in radio. Almost everyone remembers his years on "American Top 40" or hearing him as the voice of Shaggy in the cartoon, Scooby Doo. However, his final years on earth also left his fans with a cautionary tale about caregiving and the problems that can arise.

During the last couple of years of his life, Casey Kasem's family was torn about his caregiving needs. On one side were his children from his first marriage, and on the other side was his second wife. Their bickering led to very public court battles, and it culminated in his wife moving Kasem without telling his children of his location. In the end, one of his children was appointed his custodian, and thankfully his entire family was able to see him before he passed.

Family Conflict and Caregiving

Family conflict over issues of caregiving is a common problem in estate planning and elder law offices. Typically, most conversations regarding caregiving occur too late, and they only happen after a person in the family is in need of serious care. When the caregiving conversation happens too late oftentimes the person in need is no longer in the position to contribute to the decision making process about their own care.

As a result, family battles arise and questions about long-term financial needs are often at the forefront of the conversation. In most cases, the spouse is considered the primary decision maker for medical and financial choices; however, without certain documents like a medical and durable power of attorney, living will, and advance directive family members will fight for the right to make caregiving decisions.

Having the C.A.R.E. Conversation

The 40/70 rule, also known as the caregiving conversation rule, states that when a child reaches forty years old or a parent reaches seventy, whichever comes first, the conversation about long-term care and end of life decisions needs to occur. The C.A.R.E. acronym is a step by step instruction on how to have the caregiving conversation:

· C: Create the conversation. Using stories such as Casey Kasem can be a great icebreaker when bringing up long-term care wishes.

· A: Acknowledge wishes. While as the caregiver you may think that you know best it is important to acknowledge the long-term care and end of life wishes of your loved one. The conversation goes best when it is approached as a partnership or collaboration for what the parent wants and needs.

· R: Review all documentation. Review all legal, financial, and personal documents for your parent. Ensure that all of their wishes are fully documented and that all documentation is up to date.

· E: Engage the entire family. Make sure that all family members are involved in the conversation about the long-term care and end of life wishes of your loved one. Explaining why certain choices were made and ensuring that everyone feels included in the process can avoid future problems before they happen.

The added trauma of family squabbles can hasten a loved one's demise by causing undue stress in an already difficult situation. Casey Kasem's legacy has taught us that it is important to have the caregiving conversation, and have it early, to ensure that the issues faced by his family do not happen to ours.

June 30, 2014

The Growing Importance of Social Supports for Seniors

When most people think of senior care they think only of the medical aspects of care. This includes medication, access to doctors and hospitals, and skilled nursing facilities. However, there is another side to elder care that is now growing in attention and recognition, and that is social supports for senior care.

What are Social Supports?

The medical side of senior care is controlled by doctors, hospitals, drug companies, Medicare, and Medicaid. They encourage the use of pharmaceutical drugs, medical procedures, and diagnostic tests. Social supports are facets of senior care not paid for by Medicare and instead fall under a "softer" term of wellbeing. This area includes:

· Community and family assistance
· Good nutrition
· Exercise
· Access to transportation
· Safe housing

...and other, "fuzzier" aspects of senior life that contribute to overall wellbeing and quality of life.

Research in Social Supports

Until recently, most doctors and medical professionals discounted the benefits of social supports. It is difficult to write a prescription for more social interaction or scientifically gauge how much it is helping. However, two reports have recently been published that illustrate the benefits of social supports and how they can help the medical side of senior care.

The first study was done by the United Health Foundation, called "America's Health Rankings Senior Report." The report measured which states are the healthiest, and which are the least, for seniors. In order to determine which states were healthiest the report used typical medical indicators such as health care providers, preventable hospitalizations, and the like. However, the study also included access to social supports in its findings. Factors included the percentage of seniors getting good nutrition, physical activity, and volunteerism. Using these indicators in its report signaled to medical professionals that social supports matter when determining what is healthy for seniors.

The second study was published by The Commonwealth Fund, entitled "Addressing Patients' Social Needs: An Emerging Business Case for Provider Investment." This organization has historically only focused on medical care for seniors, but it is now starting to see the value in social supports in long-term care. The paper explains how programs can successfully integrate medical and social care into one comprehensive package for seniors.

How Social Supports Aid in Senior Care

The message from both papers is simple - social supports help improve outcomes and in the long term can save money in elder care. A healthcare plan in Minnesota recently adopted an integrated plan of medical and social services. It has reported a significant decrease in hospital stays and emergency room visits since the inclusion of social supports in its program. Although it is still in its early stages, the combination of medical and social support services into a single program has the potential to increase the quality of life for seniors and aid in their long-term care. While some advocates are concerned that the combination of programs may medicalize social support systems, most are upbeat about the possibility of medical professionals recognizing the benefits of social supports in elder care.

June 26, 2014

Study Finds Massive Gap in Healthcare Quality between States

According to a new report published by the AARP, The Commonwealth Fund, and the SCAN Foundation the quality of long-term healthcare and services can vary greatly depending on where you live. The study looked at almost two dozen different qualities of long-term healthcare, including:

· Access to Medicaid home care programs
· Quality and cost of nursing home and home care
· Private care insurance coverage
· Number of home and personal care aides
· Number of assisted living and residential care units
· Quality of life and level of stress of family caregivers
· Percent of home care patients with hospital admission, and more.

Two major trends stood out within the report. First, the consistency of care in the top-rated and bottom-rated states was very steady. The highest ranked states in the study included Minnesota, Washington, Oregon, Colorado, Alaska, Hawaii, Vermont, and Wisconsin. These states scored highly in nearly every category in the study. The lowest ranked states in the report were Kentucky, Alabama, Tennessee, Mississippi, West Virginia, and Indiana. These states consistently scored average to low in nearly every category of the study.

The second trend seen within the report was the huge gap between states in their levels of care. The best states in the study did far better than the worst states, and the gap between the two groups is substantial. This shows that the worst ranked states have the capacity to give much better long-term healthcare services to their citizens if they wanted to.

The United Health Foundation recently released its own state survey that focused on quality of life issues for seniors. The studies are not identical - the AARP's study focused on long-term support and services while United's survey was broadly focused on senior quality of life - but the results from both reports is strikingly similar. In United's survey the top ranked states for quality of life for seniors included Minnesota, Hawaii, Colorado, and Oregon. Likewise, Kentucky, Mississippi, West Virginia, and Alabama all landed in the study's worst ranked states, as well.

The results of these surveys do not mean that every senior needs to move to Minnesota. Both the AARP and United studies omit more subjective factors that affect the quality of life and care for seniors such as the effect of harsh winters or being close to family. They also did not ask whether or not a competent family caregiver was present in the seniors' lives. What they do show is that some states have figured out how to provide high quality long-term healthcare for its seniors and suggest that other states can do better in their care for the elderly. This may mean looking to other states' healthcare systems for suggestions, reviewing home state policies, or committing more state resources to elder care.

June 24, 2014

Using Baseball to Help with Alzheimer's

Located at Riverdale in the Bronx, the healthcare workers at the Hebrew Home assisted living care facility are using baseball as a way to help the residents suffering from Alzheimer's and other memory issues. Coinciding with the exhibition of Yankee's memorabilia at the Hebrew Home that opened on Father's Day, therapists are using baseball to help residents recall long-forgotten good memories.

Baseball is still considered one of the best and favorite pastimes of residents at the Hebrew Home, and the residents' connection to the sport is what spawned the idea to use it as a therapy tool. The Home is integrating baseball into many of its programs and activities such as art therapy and poetry workshops throughout the rest of baseball season. In art class, residents are encouraged to make their own baseball cards. In poetry, residents recall their favorite memories about baseball and use their experiences to craft their own poems.

Residents at the Hebrew Home have responded well to the integration of baseball into the programs. Therapists have seen residents with Alzheimer's and other memory problems recalling memories from decades ago about their favorite baseball experiences. One resident remembered going to games with her children after her husband passed away as a way of bringing the family closer together. Other residents still remember the statistics for some of the most famous Yankee players like DiMaggio. One resident still remembers going to his first Yankee's game in fifth grade.

In addition to integrating baseball into therapy programs, the Hebrew Home also opened the Yankee's memorabilia exhibit. With over two dozen different pieces of Yankee's memorabilia on display for the seniors the permanent exhibit opened on Father's Day this year. Former Yankee Ron Blomberg even made an appearance to commemorate the opening of the exhibit. Pieces in the exhibit include part of a dugout, baseball bats used by Reggie Jackson and Derek Jeter, and even a diary entry from Joe DiMaggio.

This is not the first time that baseball has been used to help seniors suffering from Alzheimer's and other memory issues. The Saint Louis Cardinals teamed up with the Alzheimer's Association, Saint Louis University, and the Saint Louis V.A. to create the Cardinals Reminiscence League. Families with senior members who suffer from Alzheimer's meet twice monthly to discuss baseball, tour the stadium, and even hold artifacts from the Cardinal's Hall of Fame. The Reminiscence League has been helping seniors with memory problems by recalling fond memories about baseball and the Cardinals team. Some members have recalled sneaking into playoff games at the stadium, collecting cards and other memorabilia from the team, and simply remember the joy of playing baseball themselves.

June 18, 2014

NY Elder Care - The Next Big Technological Opportunity

By the year 2016, the projected cost of elder care in the United States will be $319 billion, and it is quickly becoming an incredible burden on seniors with fixed incomes as well as their families. As a result, more and more people are choosing at-home care for their elders. One obvious upside to at-home care is the relief that it gives the retirement and nursing home infrastructure; however, another positive result has been the advancement of elder care safety monitoring and assistance technology.

Elder care technology has advanced considerably since the days of the "I've fallen and I can't get up" medical alarm buttons from Life Call. New technology includes bio-sensors, cloud networks of medical records, and robotics. One of the companies on the forefront of elder care technology is Vital Connect. It has developed wearable health sensors that track everything from heart rate and body temperature to sensing falls and other accidents.

Decreasing Elder Care Costs

New research has been released that found that the new technology in elder care is driving down long-term costs. In Great Britain, emergency visits have been reduced by twenty percent for elders wearing health sensors and "telehealth" monitors. In the United States, the FCC estimated that the use of health sensors in hospitals has reduced the cost of hospital-born infection by $12,000 per patient. However, the biggest reduction in costs with new elder care technology is in live-in care. Typically, live-in care for seniors can cost anywhere from $3,000 to $6,000 per month. With the use of elder care technology and health monitoring sensors the need for live-in care can be delayed by months or even years for seniors still living on their own.

Additional Benefits of Elder Care Technology

One added benefit of the development of new technology is the increased quality of life and autonomy for elders. Seniors are getting the opportunity to make more decisions regarding their healthcare options and general life decisions because of the decreasing need for live-in care, emergency visits, and overall costs. By keeping elders out of the assisted living and nursing home systems they are left with more money and choices in their twilight years.

The Future of Elder Care Technology

Even though elder care technology is still in its early development stages the market is booming. Over 138 companies are now raising equity and financing that specialize in technology for seniors. Even large cable providers are getting involved in the elder care technology sector and are planning on selling elder care services to its customers within the next two years. Because of the increasing demand, high costs for alternatives, and large number of new companies in the market the elder care industry is poised to see some of the biggest technological changes of any sector in the coming years.

For help putting financial plans in place to secure access to the best elder care, be sure to contact an elder law estate planning attorney today.

June 16, 2014

New Trend in Elder Care - Sending Seniors Abroad?

The World Health Organization estimates that by 2050, the number of people who live past their 80th birthday will be roughly 395 million, more than quadruple the current number. Additionally, the Alzheimer's Society has found that over 80% of residents in nursing homes and assisted living care now have dementia or some type of serious memory problems. These types of issues demand constant care and considerable cost. With an increasing number of seniors worldwide and the skyrocketing costs, younger generations are looking for new options in elder care. A growing trend in elder care is to send seniors to living care facilities abroad in countries such as Thailand, where the costs of care are lower and the care is more comprehensive.

Benefits of Elder Care Abroad

The biggest reason that people are looking at elder care abroad is cost. In the United States, live-in care can cost anywhere from $3,000 to $6,000 per month. Assisted living or nursing home care can be even more expensive. In other countries, elder care costs are just as high. In the United Kingdom, cost ranges from US $3,600 to $5,000 per month, and in Switzerland elder care costs run monthly on average from US $5,000 to $10,000. However, in places like Thailand the cost of elder care runs at maximum around $3,000 per month and the level of care are much more comprehensive. At that price three or four caretakers look after a single patient, and 24-hour care is very feasible.

Another reason people are looking abroad for elder care is the culture. In places like Thailand and China there is a strong culture of caring for the elderly. China's Ministry of Civil Affairs recently announced plans to build twelve retirement resorts for the elderly in China and Dubai. Because the idea of filial piety is considered "the first among 100 virtues" the care of seniors in these countries takes priority over almost everything else.

Potential Drawbacks of Elder Care Abroad

As some have pointed out, there are also potential drawbacks to sending seniors abroad for their elder care. The first and most important issue is safety. Regardless of the culture of the community, elder care accidents and neglect can still occur. It is more difficult to discover these types of incidents when your elders are thousands of miles away.

Another potential drawback is ensuring that the care changes effectively over time. The needs of a senior one year may not be the same the next. Face to face contact with your elders and doctors is the best way to decide what changes in care are needed, and even with electronic communication like phone calls and Skype it can be difficult to monitor care from a long distance.

The Future of Elder Care Abroad

Despite the potential drawbacks, sending elders abroad for care continues to be an emergent trend in the elder care sector. This is especially true for seniors with dementia or severe memory problems. With rising costs of healthcare for seniors and the difficulty of dealing with certain mental and health issues at home, sending elders around the world for care will be a trend that we should expect to continue to grow.

June 13, 2014

Casey Kasem & The Importance of an Advance Directive

In a ruling Monday, Judge Daniel S. Murphy ordered that renowned radio personality Casey Kasem must be fed, hydrated, and medicated at the discretion of his doctors. This order is the latest in a string of court battles between Kasem's wife and children about his medical care. Casey Kasem suffers from a form of dementia similar to Parkinson's and is no longer able to communicate with his family. Last month his wife, Jean, moved him from his care facility in Santa Monica to a friend's home in the state of Washington without disclosing his whereabouts to his children, and after the incident Kasem's daughter, Kerri, was named as his temporary conservator. This latest order comes from Kerri's request that doctors begin end-of-life procedures for her father. Kasem's wife vehemently opposed the request and argued that she feels like he would want to live as long as possible.

All of these arguments could have been avoided if Casey Kasem had filled out an advance directive that gave clear directions for his final wishes about his medical care.

What is an Advance Directive?

An advance directive is two legal documents, a living will and medical power of attorney, which together detail all decisions regarding medical care and final wishes. The directive allows you to communicate your wishes even if you are physically unable to communicate later on.

· Living will
A living will allows you to document your wishes for specific treatments and options for end-of-life care. You can specifically state what you do and do not want when faced with a serious or life altering illness. A living will can be specific for types of treatments or be disease specific depending on your preferences.

· Medical Power of Attorney
A medical power of attorney appoints a special person to make medical decisions for you if you are no longer able to make them for yourself. Otherwise known as a surrogate decision maker, the person appointed by medical power of attorney should follow the directives set out by you in your living will for your medical care.

The Future of Casey Kasem's Care

Another hearing is set at the end of this week for the judge to hear a report from a court-appointed attorney about what he learned this week after speaking with Kasem's doctors. His daughter's attorney stated that end-of-life measures should be taken because feeding, hydrating, and medicating Kasem had been deemed too painful by his doctors. In addition, Kasem is apparently unable to eat on his own, and his body is rejecting food. His wife is accusing his daughter of expediting his death in order to hasten a $2 million distribution of his inheritance. Without an advance directive, these court battles over Kasem's medical care are likely to continue for the foreseeable future.

June 11, 2014

Considerations When Researching Continuing Care Retirement Facilities

Choosing to move into a continuing care retirement facility (CCRF) is one of the biggest decisions you can make in your later years. A lot of factors go into getting financial matters in place and ensuring that a particular facility is right for you. However, there are some resources and tips that can make the process of choosing a continuing care facility a little more manageable.

Resources for Finding a Reputable CCRF

According to the National Investment Center for Seniors Housing & Care Industry in the United States there are over 2,000 continuing care facilities with more than 600,000 residents. CCRFs can be nonprofit or for-profit entities. For a list of nonprofit care facilities, you can research your options at Leading Age, and for a list of all facilities including those for-profit you can research communities (for a $24.95 fee) at the Retirement Living Information Center.

Another consideration when researching CCRF options is to see whether or not the community is CARF accredited. The Commission on Accreditation of Rehabilitation Facilities, or CARF, has a voluntary accreditation process that ensures that the facility has a commitment to high quality operational and service standards. However, the process is quite expensive so you should not automatically discount care facilities purely because it lacks CARF accreditation.

Other Considerations when Researching CCRFs

Once you have narrowed your search to a few CCRFs from the national lists more specific attributes of each facility should be researched. Here are a few other considerations that should be taken into account when choosing a continuing care facility:

· Look at the community license
Every state has its own licensing for CCRFs, and when visiting you should see the license prominently visible with contact information for the specific report for that facility. The report can give you information regarding staffing, accidents, or other major program deficiencies.

· Research the financial contract options
Most financial options are broken into Type A, Type B, and Type C contracts. Buying into a CCRF is a very complicated financial transaction because you are combining a place to stay with long term care insurance. An experienced elder law attorney will be able to look at the available contract options, as well as any potential refunds, and explain them to you in an understandable way.

· Look at amenities provided
The available amenities at a CCRF can often make or break a place for potential residents. Does the facility have a doctor and hairdresser on site? Are there events that allow for socialization with other residents? What is the pet policy? Is there a fitness center on site or transportation to outside facilities? All of these options and more should be looked into before choosing a CCRF.

· What is the availability in skilled nursing wings
When choosing a CCRF you are planning for three stages of stay: independent living, assisted living, and skilled nursing care. As the average age of residents is increasing the availability in skilled nursing is decreasing. Check the options for each facility in regards to its skilled nursing care as well as any hidden costs or fees.

· Ask for a trial stay
Most CCRFs have a trial program for potential residents where you can stay for a week or two and get a true feel for the facility. It gives you the opportunity to get to know the staff, learn the routines, and get a true feel for the place. If no overnight program exists try to visit a few times at different times of the day or for a whole day in order to know how the facility operates.

· Talk to current residents
Every reputable CCRF has some type of residents' counsel. Speak with members of the counsel and other residents in order to get a true and unbiased opinion of the facility. The current residents will be able to give you the most realistic and honest opinion about all aspects of the community.

June 5, 2014

Avoiding Probate By Using Beneficiary Designations

In New York, there are several ways to distribute assets at your death other than through provisions in a will or trust. In fact, it is possible to dispose of many of their assets by using "beneficiary designations."

Pay On Death Accounts

"Pay On Death" (POD) accounts (also called Transfer on Death or TOD accounts) are arrangements between a bank, credit union, brokerage or other financial institution and a client. These arrangements allow the client to designate a beneficiary who will receive the client's assets if the client dies. These assets could include money, savings bonds, stocks, bonds or other account holdings.

With POD accounts, the client owns and controls the account and the assets in it until the client dies. This means that the client can spend any of the assets in the account and can even close the account. This is because the beneficiary has absolutely no rights to the account until the client dies, assuming the beneficiary is still named on the account at the time of the client's death.

POD Account Where The Account Is Co-Owned

If the POD asset is jointly owned (like a joint bank account between spouses), the POD beneficiary inherits the account only after both owners die. If the spouses die separately, the surviving spouse generally receives the account under a "right of survivorship." The surviving spouse then owns the account outright and has the right to dispose of the account assets as he or she sees fit. The surviving spouse also may revoke the original beneficiary and name a new one.

Claiming POD Assets Upon The Death Of The Client

Assets in a POD account transfer by operation of law upon the client's death. This means that the transfer of assets is automatically triggered by the client's death and occurs immediately.

The exact procedure for claiming POD assets depends on the asset. Generally, the process involves the following---

Bank Accounts

After the death of a POD client, the POD beneficiary can claim the money in a bank account by presenting a certified copy of the client's death certificate along with proof of the POD beneficiary's identity (such as a driver's license, birth certificate, or passport). If the POD account named more than one beneficiary and not all of them survived the POD client, then the surviving beneficiary (or beneficiaries if there is more than one) must also present certified copies of the death certificates of the deceased beneficiaries.

Certificates Of Deposit (CDs)

Certificates of deposit are claimed similarly to Bank Accounts. However, while a beneficiary can typically close a CD without an early withdrawal penalty, transferring ownership to the beneficiary but keeping the account open sometimes presents issues.

The problem of claiming a CD arises in situations where the CD was opened when interest rates were high and the beneficiary wants to benefit from favorable interest terms. While some banks and credit unions will convert the original CD into the beneficiary's name and allow the beneficiary to keep the original CD interest rate and maturity date. Others, however, require that the original CD be close before the beneficiary can take ownership of the CD funds. The closing of the original account terminates the original favorable terms and the beneficiary must then open the new account under current rates and terms.

Brokerage Accounts

Brokerage accounts typically allow a client to establish a designated beneficiary "plan." The plan document then sets out what will happen with the account funds upon the client's death. For example, a brokerage account plan may require a beneficiary to provide information including a completed designated beneficiary plan distribution form, a certified copy of the client's death certificate, a notarized affidavit of domicile, and a tax waiver if required by state law. Proof of the beneficiary's date of birth and relationship to the client account holder also may be required.

Brokerages also frequently reserve the right to require additional documentation, to consult counsel, and to initiate legal proceedings in order to determine the proper distribution of account assets. They also may withhold a portion of the funds payable to the beneficiary for the payment of applicable taxes.

For help with these and similar issues, be sure to contact an NY experienced elder law estate planning attorney today.

May 29, 2014

New York Program Helping Senior Tenants with Rent Caps

Last week New York City announced plans to expand its legislative program that helps senior tenants freeze their rent and make living on their own more affordable. Mayor Bill de Blasio has cited a lack of affordable housing as a major problem, and the elderly who live on a fixed income are particularly disadvantaged when it comes to rent increases. In the past, elderly renters have not participated due to language barriers, lack of computer access, and challenges travelling to get the proper paperwork. However, new funding and a public awareness campaign are helping more seniors sign up for the program. The campaign is also aimed at the adult children of elderly renters in hopes that they will help their parents sign up for the program.

What is SCRIE?

SCRIE, or the Senior Citizen Rent Increase Exemption, is a program that began in New York City in 1970. The program allows renters in New York City to freeze their rent at its current level if certain qualifiers apply. In exchange for the frozen rent, landlords of these apartments are given property tax rebates. State legislation is now contributing millions of dollars in financing over the next two years to expand the initiative and provide more information to seniors.

Do I Qualify for the Program?

In order to qualify for the SCRIE program a renter must be age 62 or older, live in a rent-regulated apartment, and spend at least one-third of the household income in rent. Currently, the maximum annual income allowed to participate in the program is $29,000 but as of July 1st this cap will be raised to $50,000 annually.

If you have already attempted to apply for SCRIE but were denied, officials are urging seniors to apply again after July 1st when the updated regulations go into effect. Letters are also being mailed to all who have been denied in the last five years with the new information and are encouraged to try again. It is estimated that tens of thousands of new elderly renters will qualify for rent freezing once the updated regulations go into effect.

Where Can I Find More Information?

The city is trying hard to expand the ways in which seniors can get access to information and apply to SCRIE. The city's Department of Housing Preservation and Development has information about the initiative on their website. The New York City Department of Finance also has a website that gives information about the SCRIE program as well as provides the necessary forms needed to apply for assistance. Information can be obtained over the phone by calling 311 and asking for the forms on SCRIE, and a walk-in clinic is also open in Manhattan.

For help with elder law estate planning issues throughout New York, contact experienced attorneys as soon as feasible.

May 27, 2014

Increasing Workplace Elder Care Benefits

According to new research, over forty percent of Americans are caring for their elderly family members, and most are doing so in addition to managing their careers. Cartoonist Roz Chast illustrated these difficulties in her memoir detailing the care of her parents in their final years. However, more employers are realizing the need to help their employees who are similarly struggling with balancing elder care in addition to their jobs, and as a result elder care benefits in the workplace are on the rise.

The Families and Work Institute recently published a new report, the 2014 National Study of Employers, which detailed the growing trends in elder care support and benefits in the workplace from 2008 to 2014. Some of the key findings of this report include:

· 75% of employers surveyed provide time off for employees to provide elder care without jeopardizing their jobs
· Employers are now more likely to report that they offer elder care resource and referral programs
· More employers are offering DCAPs (Dependent Care Assistance Programs) and access to respite care

It is interesting to note that the Family and Medical Leave Act (FMLA) does not expressly provide for the care of the elderly; however, more employers are still incorporating elder care into their workplace benefits. Some of the leading causes for the increase in elder care benefits includes an aging upper management that are more likely to personally experience elder care issues, an overall aging workforce, an increase in the number of employees dealing with managing elder care, and an immediate expectation in the next five years of needing elder care benefits for those who are not already providing care for a loved one.

Not all employers are equal when it comes to providing elder care benefits to its employees. When predicting whether or not an employer is likely to provide elder care benefits, the report stated that those most likely to provide care are typically characterized as:

· Large companies
· Nonprofits
· Operating in multiple locations
· Having fewer hourly employees
· Having more women employees
· Having more women and minorities that are in or report directly to executive leadership

...however, many other employers that do not fit the characterizations of this list are also providing elder care benefits for their employees. The simplest way to figure out whether or not an employer is providing elder care benefits is to ask.

Roz Chast has an illustration in her memoir with the caption, "You are Here, Suck it Up." However, with increasing elder care benefits in the workplace, fewer employees are being forced to "suck it up" when it comes to balancing their jobs and the care of their loved ones.

For a more detailed analysis about workplace elder care benefits, see the Families and Work Institute website for more information. For legal help with elder law issues, be sure to contact an attorney experienced with these matters.