December 12, 2014

Efforts to Decrease Levels of Elder Financial Abuse

According to Kiplinger's, elder financial abuse has been named the "crime of the 21st century," and according to a new study in the Journal of General Internal Medicine, as many as twenty percent of America's elderly population may be victims. However, new efforts by attorneys are being made to train people in this profession to spot and report potential elder financial abuse and fraud.

EIFFE Initiative

The Elder Investment Fraud and Financial Exploitation prevention program (EIFFE) was launched by a joint effort between the American Bar Association (ABA), nonprofit Investor Protection Trust, and its sister organization the Investor Protection Institute. The goal of EIFFE is to curb the increasing levels of elder financial abuse and exploitation by teaching attorneys how to spot the warning signs.

The program is focused on attorneys because they are helping seniors with estate planning, wills, powers of attorney, and other legal documents and are in a position to spot a person at risk of financial exploitation. The program so far has been met with enthusiasm, and ninety percent of the attorneys surveyed by the groups before launching the program said that they would be willing to participate as part of a continuing education program that is about "detecting preventing and redressing elder investment fraud and financial exploitation."

How the Initiative Works

The program is set up as an option for continuing legal education for attorneys. Lawyers will be taught how to recognize a client's possible vulnerability due to mild cognitive impairment or incipient dementia in addition to identify clients who are victims and report suspected instances of elder fraud and exploitation to authorities. This initiative complements the interactive, online curriculum just launched by the Department of Justice to teach attorneys how to identify and respond to all kinds of elder abuse.

The Importance of the EIFFE

Lawyers need help detecting signs of potential elder fraud problems; however, spotting, preventing and responding to financial exploitation is not an area where many attorneys are effectively trained. Roughly one-third of elderly Americans over the age of 71 have some kind of cognitive impairment, and that number is expected to rise. This type of impairment makes people more likely to make financial errors or be less able to evaluate potential financial risk.

According to the New York State Elder Abuse Prevalence Study, for every case of elder exploitation reported, as many as 44 other cases go unnoticed. In addition, the survey by EIFFE organizations found that 91% of attorneys find elder investment fraud and financial exploitation a serious problem, and as many as 34% said that they believe that they are or may be dealing with such victims on a daily, weekly, or monthly basis.

Attorneys will start taking the EIFFE education course in five states at the end of the year, and the program hopes to spread nationally by next spring. Attorneys that participate in the program are not just helping their elderly clients, but they are protecting themselves, too. Lawyers who fail to detect and report elder financial abuse can become unwitting participants in the exploitation. This opens them up to civil, criminal, and professional penalties for their part in the abuse.

December 9, 2014

Developing Efforts to Curb Elderly Addiction

The increase in the number of elderly Baby Boomers has also meant an increase in the number of seniors abusing medication, other drugs, and alcohol. There are many delicate issues that arise in treating the elderly for addiction. However, efforts are now being made to screen and treat instances of elderly addiction in hospitals, nursing homes, and other treatment programs.

Elderly Addiction Statistics

Experts agree that as the population of seniors grows so does the number of those addicted to harmful substances. In 2009, a study was published that found that because of the large size "and high substance abuse rate" of the Baby Boomer generation, the number of Americans over the age of fifty with addiction abuse problems was expected to reach 5.7 million by 2020, double the number from 2006.

Seniors are getting addicted to multiple types of drugs and for a variety of reasons. Some turn to substances because of a fear of aging, chronic pain, or other debilitating cause. Many seniors turn to alcohol, but others are overprescribed powerful pain medications or other narcotic drugs. In addition, many family members, friends, and even doctors can miss the signs of addiction and mistake it simply for old age.

Treatment Programs

The Jewish Home Lifecare nursing home in New York City's Bronx neighborhood has started a treatment program for seniors suffering from addiction. Patients that are age sixty or older who come to the nursing home for rehabilitation after a hospital stay are screened for addiction and offered a chance for treatment. As of now, eight beds inside the nursing home are set aside for addicted seniors, and the facility expects to get as many as 480 patients for the program per year.

Alcoholics Anonymous is also offering services specifically tailored to seniors. The organization is hosting special meetings in nursing homes, offering transportation to frail members or even bringing meetings to the homebound. In addition, the Odyssey House has residential and outpatient treatment for elderly addicts and the Betty Ford Foundation has an addiction treatment "track" in Florida called BoomersPlus. In that program, all of the addicts are ages fifty and older.

How Treatment Works

For many addicted seniors that have taken part in an elderly-specific treatment program, they say that being with others their own age helps quite a lot because it is easier to dismiss people younger and with less life experience. This has been particularly effective in programs like Alcoholics Anonymous and Narcotics Anonymous.

In the Jewish Home Lifecare center, the addiction treatment program combines physical, occupational and psychological therapy with counseling. Patients discharged from hospitals to the nursing home for medical rehabilitation stay for an average of only 23 days. This is typically because Medicaid will not pay for addiction care beyond the medical care needed.

Therefore, for Jewish Home Lifecare a lot of importance is placed on discharge plan for their addicted elderly. The recovery plan includes putting a support team in place, arranging transportation to AA, or having a visiting nurse keep an eye out for signs of relapse. The nursing home hopes that other facilities will soon copy their treatment program elsewhere and get even more addicted seniors the help that they need.

December 5, 2014

Focusing on the Caregiver: Seeing the Invisible Patient

Very few caregivers are ever asked by their loved one's doctors or other professionals how they are coping with the care of another. Questions like whether the caregiver is eating properly, exercising, sleeping enough, become depressed, or getting any free time is often overlooked. Thankfully, some physicians and other healthcare professionals have noticed the lack of care given to the actual caregivers, and they are doing something about it.

The Invisible Patient

Dr. Ronald D. Adelman, co-chief of geriatrics and palliative medicine at Weill Cornell Medical College recently gave a talk in addition to publishing an article about "the invisible patient," the caregivers of the elderly. He contends that doctors should be assessing caregivers when they check on their elderly patients.

The invisible patient refers specifically to a person supporting an elderly family member with dementia, heart disease, diabetes, or all of the above. Currently in the United States there are over 43.5 million people providing this type of care to a loved one over the age of fifty.

Recommendations for Caregiver Assessment

Dr. Adelman recently published an article in the Journal of the American Medical Association discussing the burden of caregivers with the objectives of providing strategies to diagnose, assess, and intervene for caregiver burden in clinical practice as well as evaluating evidence on interventions intended to avert or mitigate caregiver burden and related caregiver distress. He found that physicians have a responsibility to recognize caregiver burden. In addition, caregiver assessment and intervention should be tailored to the individual circumstances and contexts in which caregiver burden occurs.

Some of the risk factors for the invisible patient that should trigger assessment by doctors include:

Being a woman
The number of hours of care provided
The complexity of medical tasks such as dealing with wounds, catheters and complex medication routines
Transitions from one kind and location of care to another, like from home to hospital, to rehab, to skilled nursing care or to hospice
Financial distress
Level of cognitive impairment in the patient
A less educated caregiver
A caregiver who lives with the patient
A lack of choice in assuming the caregiving role

The recommendations given in the article for treating physicians are fairly straightforward. It includes asking a caregiver a simple question like how they are doing, to more complex questions about making other arrangements for care if something were to happen to the caregiver. The article also encourages doctors to use a toolkit to assess the needs of the caregivers provided by the Family Caregiver Alliance.

Resources for Caregivers

In larger teaching hospitals, there are usually social workers and other professionals on staff to assess caregivers when their loved ones are brought in for treatment. Some hospitals are requiring that all medical students spend at least one rotation on the geriatric floor, regardless of their career aspirations, in order to understand and appreciate the warning signs for caregivers.

Doctors in the private practice are already used to making referrals to medical specialists, but this recent study encourages the development of a network for nonmedical referrals, too. Community agencies, visiting nurse services, geriatric care managers, elder care lawyers, and the like can all be utilized to help the invisible patients care for their loved ones.

December 2, 2014

Bullying and Conflict in Nursing Homes

New research released last week reported that conflict and violence among nursing home residents is widespread and that extremely high rates of violence are common in some facilities. The author of the study, Karl Pillemer, is a professor of gerontology at Weill Cornell College of Medicine, and he presented his findings at the annual meeting of the Gerontological Society of America. According to Professor Pillemer, over twenty percent of people living in the nursing homes studied were involved in at least one negative or aggressive encounter with another resident during a four week period.

Nursing Home Study

For the study, researchers looked at patient records at ten nursing homes in New York. They interviewed staff and residents and recorded incidents through direct observation. In a sample of over 2,000 residents, sixteen percent were involved in incidents that included swearing, screaming, or yelling.

In addition, six percent were involved in physical violence like hitting, kicking, or biting, one percent had "sexual incidents, such as exposing one's genitals, touching other residents, or attempting to gain sexual favors" and over ten percent were involved in events that the researchers labeled "other." This included situations where residents entered rooms uninvited or rummaged through another resident's belongings.

Resident on Resident Aggression

While the study of nursing home abuse at the hands of staff or other authority figures is increasing, the amount of research for resident on resident incidents of bullying and conflict has received far less study or publicity. However, these incidents of violence and aggression happen all of the time. Professor Pillemer's study found that the residents involved in acts of bullying tend to those more active, engaged, and cognitively intact in a nursing home.

However, mild to moderate dementia has also been shown to play a role in aggression because it can cause disinhibited behavior. Other factors that lead to an increase in conflict or violence in a nursing home facility include:

· Crowded conditions
· Understaffing
· Apathetic nursing home staff
· Conflict's cyclical nature

The study found that crowded conditions in a nursing home lead to higher rates of mistreatment among the elderly, especially in areas where residents are more densely gathered. In addition, facilities that are understaffed with lower staff to resident ratios also saw a higher instance of conflict among the residents.

Apathy among the nursing home staff can also lead to more aggression amongst the residents. Staff can become somewhat blinded to the problem because of the frequency with which it occurs. Finally, the study found that the cyclical nature of conflict can also have a detrimental effect and lead to higher rates of bullying among nursing home residents. Negative behavior and its results are contagious. Seeing these incidents can cause other residents to be fearful, anxious, and concerned which in turn leads to more negative behavior.

How to Address the Aggression

In many ways, aggression and conflict among nursing home residents is more complicated than typical forms of elder abuse. When a family member or nursing-home worker abuses an elder, the perpetrator is clear to an outsider. However, resident on resident aggression is a lot less clear cut.
Many experts believe that looking at causes and prevention, instead of in terms of perpetrator, victim, and punishment, nursing homes can improve care. It is also important to remember that seniors in nursing homes are some of the most vulnerable members of our society. Even if residents are perpetrating these acts, many believe that they should not be held accountable.

Many experts believe that it is the nursing home's responsibility to ease aggression in their facilities, and the best way to accomplish this is by getting to the root of the issue. If staffing is an issue, hire more people. Personalizing care for residents can also be a way to reduce the amount of bullying and co

November 27, 2014

LGBT Spouses Denied Social Security Survivors' Benefits

Grieving LGBT spouses who recently lost a loved one are being dealt another harsh blow by the Social Security Administration, which is refusing to pay survivors' benefits to same-sex spouses living in states where their marriage is not recognized. One couple married in Boston but living in Texas was together for over thirty years when one passed away from cancer. The SSA refused to pay benefits to the surviving spouse because although they were married in a state that recognized the union, their state of residence does not.

Survivors' Benefits Lawsuit

As of now, Social Security will not approve applications for spousal or survivors' benefits for LGBT couples in Texas and sixteen other states that still do not recognize same-sex marriage. In order to get justice for herself as well as other same-sex widows and widowers, Kathy Murphy, 62, and the National Committee to Preserve Social Security and Medicare are suing the Social Security Administration claiming that denying benefits to married same-sex couples is unconstitutional discrimination.

Quick History of LGBT Benefits Law

In 2010, when Ms. Murphy and her now deceased wife were married the federal Defense of Marriage Act prevented same-sex spouses from receiving federal benefits. However, after last year when the Supreme Court ruled that parts of the act were unconstitutional in United States v. Windsor, many federal agencies began to prepare for same-sex couples to apply for benefits.

In regards to immigration and taxation purposes, same-sex couples are considered equal to heterosexual couples in the eyes of the law. In addition, LGBT couples also receive the same military benefits and federal employees receive spousal benefits regardless of orientation. However, the SSA is claiming that even though it is considered a federal agency, it must abide by state laws.

Social Security Administration Arguments

The SSA claims that the statute regarding the administration's formation requires it to follow the state laws. Furthermore, it bases the dissemination of spousal and survivor benefits not on the "place of celebration" where the couple was married but on the "place of domicile," the state where the couple lives. In terms of the pending lawsuit, the Social Security Administration claims that because Ms. Murphy lives in Texas, a state that does not recognize same-sex marriage, she was not for the purposes of Social Security benefits a widow.

Even though same-sex marriage was legalized in fifteen more states last month, the SSA is still denying benefits to couples in those states if the marriage was not recognized on the relevant date. This means that any retroactive benefits for same-sex couples in these states are not allowed.

Effects of the Social Security Rules

Who qualifies for Social Security benefits affects nearly all elderly individuals in the United States. Retirement benefits, survivor benefits, and disability payments are all at stake. For LGBT couples, the results of being denied benefits can come at a financially costly price. In Ms. Murphy's case, she had originally planned to apply for Social Security benefits at the full retirement age of 66, but she retired early to care for her ailing wife. As a result, she receives a lower pension, needed income, and was relying on spousal benefits to help until she could use her own Social Security benefits.

When added together, the financial consequences of being denied survivors' benefits are not small. Had Ms. Murphy qualified for the anticipated $1,210 per month in spousal benefits from her wife, applied for her own retirement benefits at 66, she would have ended up receiving $2,130 per month for the rest of her life. Instead, because she was denied spousal benefits, Ms. Murphy was forced to start drawing from her own benefits early and only receives $1,547 per month. The difference could add up to more than $140,000 over the rest of her life.

November 20, 2014

The Cost of Alzheimer's: $4,000 per Month?

There are over fifteen million people caring for loved ones that suffer from Alzheimer's disease, and while most are acutely aware of the emotional toll that care can take many do not realize the financial strife that it can cause, as well. According to a new survey released by AgingCare.com, over one quarter of Alzheimer's caregivers spend over $4,000 each month, around $50,000 each year, on their loved one's needs.

Breakdown of Costs

According to the same survey, these costs include a variety of goods and services. They include costs for home care, assisted living, or nursing home care. The Genworth Cost of Care Survey found that each of those services cost around $45,000, $42,000, and $87,600 (for a private room), respectively. On average, a person suffering from Alzheimer's disease lives for another eight to twelve years and at $4,000 per month the costs accumulate quickly.

Spending Either Money or Time

Those who opt not to spend around $4,000 per month on caregiving for their loved one with Alzheimer's spend a significant more amount of time. The AgingCare survey found that 38% of Alzheimer's caregivers provide more than thirty hours per week in unpaid care. The survey polled more than 1,600 caregivers for family members suffering from Alzheimer's disease or another form of dementia. Almost two-thirds of caregivers are looking after a parent, and another fifth are caring for a spouse.

Financial Toll on Caregivers

The caregivers are suffering financially almost as much as they are emotionally. Over half of the caregivers polled reported that their family finances had been strained as a result of the Alzheimer's care, and around one-fifth polled had to take on a significant debt. In addition, caregiving for Alzheimer's patients are also costing some caregivers their careers. Nearly 30% of caregivers had to reduce their working hours, one quarter had to quit their job, and seventeen percent had to take a pay cut or unpaid leave.

Planning Ahead and Getting Help

According to the same survey by AgingCare, 61% of caregivers stated that their loved one had made no financial plans for future care. Unfortunately, caregivers would be spending a lot less of their own money if the proper planning had been accomplished beforehand. As uncomfortable as it may be, you should try to plan early for the possibility of Alzheimer's and plan accordingly for care.

If you have questions about a spouse or parent qualifying for Medicaid or another benefit program, an experienced elder law attorney will be able to give you sound advice on the issue.

Even though Medicare rarely covers long-term costs like home care or nursing home care, Medicaid sometimes does; however, Alzheimer's patient must have very little in assets and income.

The rules vary by the state, but typically to qualify for Medicaid a person's monthly income cannot exceed $2,000 or $3,000. In addition, certain assets (excluding a home, car and a few other belongings) cannot be worth more than $2,000 to $15,000.

The government can also help with the burden if you can claim your loved one as a dependent and write off the eligible costs of care. The dependency exemption for 2014 is $3,950 which means that your parent must have less than that amount in gross income and you must also provide more than half of their support.

November 18, 2014

Bracing for an Increase in Falls with Our Elderly

As the population ages and people live longer, the number of elderly Americans who fall and suffer serious injuries, or death, is soaring. As a result, retirement communities, assisted living facilities, and nursing homes where millions of senior citizens reside across the nation are trying to balance the safety of their residents and their desires to live as they choose.

The Dangers of Falls

The danger surrounding elderly falls is very real. In 2012, the number of seniors ages 65 and older who died as a result of a fall reached over 24,000 people. That is almost double the number from ten years ago, according to the Centers for Disease Control.

In addition, more than 2.4 million seniors were treated at emergency rooms for fall-related injuries in 2012, an increase of over fifty percent over the last decade. In total, from 2002 to 2012, more than 200,000 elderly people in the United States have died from falls, and they are the leading cause of injury-related death for people ages 65 and over.

Precautions Being Taken

People who study and manage retirement facilities and nursing homes are now bringing in the experts to help make their communities safer for their residents. In an attempt to anticipate hazardous conditions, senior facilities are hiring architects and interior designers to help.

Some places are installing floor lighting that turns on when a resident gets out of bed and illuminates a path to the bathroom. Others are installing energy absorbing floors to make the impact of a fall softer on its residents.

Even simple precautions in nursing home facilities are helping. One facility installed a white stripe at the top and the bottom of all of their staircases to help the residents with blurry vision see where they are going. In addition, staff members at senior communities are also training on how to best approach the idea of using a cane or walker to residents who seem to be growing more unsteady on their feet.

Elderly Resistance to Fall Safety

Another way that elderly communities are trying to prevent the number of injuries related to falls is by offering a "fall education" class. Institutions offer sessions on avoiding falls and improving balance and fitness, but some residents will not go near them until after they have fallen.

In addition, many residents do not or refuse to recognize their own gradual deterioration, which in turn leaves them vulnerable despite efforts to protect them. Seniors often resist the transition to a cane or walker, as it can feel stigmatizing.

When someone does fall, oftentimes residents in nursing homes stay quiet about it. However, staff members at these facilities encourage residents to report their falls because it indicates a risk for a subsequent fall. Yet residents have a fear that they'll be whisked away and put somewhere else, and so they refuse to admit when they have fallen. As a result, some residents of these facilities have become vigilantes, and instead of reporting the fall to staff will look out for the other residents themselves.

November 14, 2014

Long-Term Care Insurance Alternatives

As many seniors reach retirement age their health can begin to decline. Yet, very few seniors have any kind of plan or coverage for chronic or long-term illness. This happens for a variety of reasons - some believe that they will pass away before this type of coverage is needed and others do not wish to think of the possibility of needing this level of care. Long-term care insurance policies as well as hybrid long-term care policies can help protect seniors, and their financial well-being, if they suffer from a long-term illness.

Necessity of Long-Term Care Coverage

As people live longer and the average age of the elderly increases, many illnesses that were once considered fatal are now manageable. Over half of all seniors will deal with some kind of chronic illness, but fewer than twenty percent have long-term care coverage. In addition, with the cost of long-term care services reaching as high as $100,000 per year, an extended or chronic illness could be financially devastating.

Alternatives to Typical Long-Term Care Insurance

One of the problems with long-term care insurance is that by the time a senior is in need of the coverage, they either have difficulty qualifying or it is too expensive. Insurance carriers are trying to rectify the issue by offering hybrid policies. They combine a life insurance policy with a long-term care component.

Another option that has been offered to seniors is a hybrid annuity. These work similarly to a hybrid insurance policy, but offer double or triple distributions in order to help seniors pay for long-term care services like a home healthcare aide or a nursing home stay.

Benefits of Long-Term Care Alternatives

An added benefit of the hybrid insurance and annuity policies is that these products can be more lenient in their qualifications and standards, making it easier for seniors to obtain them. In fact, some policies are not underwritten at all, so for elderly individuals already suffering from a chronic illness, these options are a useful solution.

Another benefit of these alternative products is in regards to the premiums. Many seniors are nervous about purchasing long-term coverage because they fear that they will die, leaving thousands of dollars in premiums that will never be used. With a hybrid product, the long-term care benefit is tied to the life insurance policy. This means that if the client dies without drawing on the benefits, it passes to the heirs tax free.

Of course, all of these hybrid products are different and come with varying terms depending on the provider. An experienced elder law and estate planning attorney will be able to go over the options and help figure out which plan would fit best.

Ultimately, these long-term care alternatives can provide seniors with a safety net in case they fall victim to a long-term or chronic illness after retirement. More importantly, it can give seniors peace of mind knowing that they are covered for this type of illness, that they will not run out of money, and that they will not need to rely on their children for financial support.

November 10, 2014

LGBT Seniors Gaining More Resources for Elder Care

With millions of Americans reaching retirement age within the Baby Boomer generation, some groups like women and minorities are especially vulnerable in their elder years. However, one of the most alienated and vulnerable groups within the elder population are that of LGBT seniors. Multiple studies have revealed that LGBT seniors are among the most isolated individuals as well as more prone to abuse and neglect.

Care Groups Paying Attention

Fortunately, a number of organizations and nonprofit groups have become aware of this issue and are dedicating their efforts to providing greater resources for LGBT seniors in addition to their caregivers. The New York Community Trust, The PFund, and Haas have all been actively working to increase the amount of resources available to LGBT seniors.

Another foundation that has been concerned about the wellbeing of LGBT seniors is the Harry and Jeanette Weinberg Foundation. Since 2009, Weinberg's Caregiver Initiative has given more than $8 million to nonprofits dedicated to helping family and friends of low to medium income seniors provide better care. A large segment of that population is part of the LGBT community.

LGBT Senior Statistics

According to a recent report released by the Weinberg Foundation, there are over three million LGBT people ages 55 and older in the United States today. That number is expected to increase by twenty percent by 2029. In addition, over half of all LGBT seniors reported that they are "very or extremely concerned" that they will outlive the money that they have saved for retirement, compared to only 25% of the heterosexual respondents.

The study also showed that LGBT seniors are half as likely to have close friends or family that they can call for help, as compared to their heterosexual peers, as well as half as likely to have life partners or significant others, more inclined to be estranged from their families, and twice as likely to live alone. Forty percent of LGBT participants also stated that they depend on family and friends for information regarding aging and resources.

SAGECAP Program

For the fifth consecutive year, the Weinberg Foundation has stepped up its support to the Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE) Caring and Preparing (SAGECAP) project, a five year old initiative to provide support for individuals who take care of older LGBT adults. Started in 2009, SAGECAP was designed to provide a welcoming community for caregivers in addition to educating them about the current and future needs of LGBT individuals.

SAGECAP provides a number of resources for LGBT seniors and their caregivers. It includes one on one counseling, group counseling, weekly caregiver support groups, educational seminars, online resources, respite care, and resources dedicated to caregivers to help them plan for their own futures.

With another $750,000 grant from the Weinberg Foundation, SAGE is able to continue providing aging resources for more than 20,000 caregivers, training caregivers for LGBT seniors through SAGECAP presentations at national conferences as well as one on one, and making guides available on issues including legal and financial planning, stress reduction, and home safety.

November 4, 2014

Talking to Elderly Parents about Giving Up Financial Control

Many children of the Baby Boomer generation are noticing the warning signs of cognitive decline in their aging parents, and as such these parents are becoming more unable to handle their own financial decisions. Typically, a parent has an estate plan in place that appoints a person, usually a child, as the person financially responsible for their wellbeing when this occurs.

However, sometimes the estate plan appoints the other, also aging and ailing parent, to make the financial decisions, or your parent never made an estate plan. If your senior parent has not created an estate plan or has named the other parent, there are steps that you can take to protect them and their financial security. Updating the Durable Power of Attorney form is a great way to ensure that your parent will be well cared for regarding their finances.

The more difficult part of dealing with your parent's finances is not drafting the necessary documents but having the conversation of transitioning financial control with your loved one. Here are some tips to help make that conversation as respectful and smooth as possible.

Acknowledge the Difficulty

One of the best ways to set the tone of the conversation is to admit to your parent that this is a difficult situation and is challenging for everyone involved. If your parent has been a powerful person during their lifetime and has "been the boss" with decision making power, this conversation can be especially difficult.

Let your parent know that you understand where they are coming from and empathize with their situation. You should try to communicate that the reason for this decision is to protect the hard work and smart financial decisions that they have made as parents throughout their lifetimes and that you are only there to help.

Choose the Right Time

You should also carefully choose the right time to have this conversation with your aging parent. Try to pick a time where they are minimal stressful events going on that could distract from this important discussion. There may be no perfect time to have the talk, but avoiding times of illness, deaths in the family, divorce, or other hardships may make it easier.

Let your Parent Choose the Meeting Place

In addition to choosing the right time to have the talk, it is equally important to pick the meeting place carefully. If possible, let your parent choose where to meet, and make sure that it is a place where they are comfortable. You should be honest about why you want to meet because it could have an effect on where they choose. Encourage your parent to tell you their concerns about the situation, and be an active listener.

Expect Resistance and Plan Ahead

Finally, you should expect some resistance from your parent when you have this conversation and do some advance planning accordingly. No one wants to think that they are too old to handle something, especially something as important as their finances. If your parent pushes back about meeting or discussing the transition, explain that you understand but it is necessary to do. Try not to push too hard, but gently persist in your efforts to have this conversation and begin the necessary transition.

October 29, 2014

Questions to Ask Before Hiring an In-Home Caregiver

The last thing that you want to do when deciding whether to hire an in-home caregiver for one or both of your parents is rush the decision. Picking this person takes time because they will be intimately involved in every part of your parent's life. However, the right caregiver can ease the pressure that you feel to ensure that your parent is being properly taken care of.

If you are unsure of where to start in the caregiver process, here are a few questions to ask yourself, your loved ones, and the caregivers that you interview.

Is in-home care the best choice?

Before you begin the caregiver search, the first question that you should be asking is whether this is the right option for care. Some people do better in a nursing home facility than at home, where they can socialize with other seniors. Elderly parents with round the clock medical needs may also need more than an in-home caregiver.

What level of assistance is needed?

There are different types of in-home caregivers available, and the right one for you will be determined by the level of care that is required. Home health aides and personal care attendants are both options as in-home caregivers. Both provide assistance with daily activities like bathing, walking and dressing, shopping, and preparing meals. However, home health aides also can provide other health-related tasks for your loved one.

What level of training and screening does the caregiver have?

State laws vary on the definitions of home health aides and personal care attendants in addition to the levels of training that are required for each type of caregiver. Make sure that the agency that you choose is licensed, bonded, insured, and up to code with the laws of your state.

If your loved one needs special care for an issue like dementia, stroke, or paralysis you should make sure that the caregiver has the special training required to handle such care. You should also ask about whether the agency performs background checks and drug tests their employees.

What is the cost, and how will bills be paid?

Make sure that you understand the entire payment package for the agency and the caregiver. Extra charges for billing, taxes, workers' compensation, itemized charges, and administrative costs can be tacked on separately or include them in a single fee for services. Furthermore, it is important to remember that neither Medicare nor other supplemental plans will cover in-home caregivers. Medicaid programs at the state level will pay for some home care services.

What are the caregiver agency's rules of operation?

Check to see what the agency's rules of operation are for their caregivers. Some require that you book a certain number of hours per week, others run round the clock, and some go off of the clock in the evening. Also, check to see what the policies are for cancellation and what backup procedure it has if the caregiver does not show.

Does your loved one like and approve of the caregiver?

The most important question of all to ask is whether your loved one likes and approves of the caregiver that is chosen. If the answer is anything but yes, the arrangement is bound to fail. To the extent that they are able, your loved one should have a say in who they want their caregiver to be.

October 27, 2014

Utica Man Accused of Nursing Home Sexual Abuse

A former employee of the Focus Rehabilitation and Nursing Center in Utica has been arrested and faces several charges after allegedly sexually abusing a resident at the facility. John Tamba, 48, of Utica is charged with three separate counts of sexual abuse, three counts of endangering the welfare of a vulnerable elderly person or an incompetent or physically disabled person, and three counts of willful violation of health laws.

According to the indictment and the New York Attorney General, Mr. Tamba allegedly engaged in forcible sexual contact with a physically disabled elderly woman who is a resident at the facility where Mr. Tamba worked. He was employed as a certified nurse's aide at the facility. He was arrested Monday and is being held without bail. If convicted, Mr. Tamba faces up to 21 years in prison for his crimes.

Nursing Home Abuse Statistics

In 2010, the United States Census recorded a record 40.3 million people, thirteen percent of the total population, aged 65 and older. By 2050, this age group is expected to account for a full fifth of the total U.S. population. Elder abuse is defined as the intentional abuse or neglect of a senior that causes harm or creates a serious risk of harm by a caregiver or other person in a trusting relationship with that elder.

Unfortunately, experts do not know exactly how often seniors are abused, but estimates are that as few as only one in fourteen cases of elder abuse goes reported or as many as one in twenty-four. Statistics show that elderly women are more likely to be abused than men, and the older that a senior is the more likely the abuse is to occur.

In 2008, there were a reported 3.2 million seniors living in nursing home facilities. One study of nursing home residents found that as many as 44% of residents said that they had been abused, and 95% claimed to have either seen the neglect of another patient or been neglected themselves.

Types of Elder Abuse and Abusers

Elder abuse is usually split into the following categories: physical, sexual, emotional, and financial abuse. Of the categories, financial abuse is the most self-reported elder abuse by the senior community. Seniors are often afraid of reporting their own abuse for fear of retaliation, lack of physical or mental ability to report, or because they do not want to get their abuser in trouble.

Over ninety percent of all elder abusers are family members of the senior. The adult children, spouses, partners, grandchildren, and other members of the family are the most common offenders. In addition, family members with a history of drug abuse, mental or emotional illness, and those who feel burdened by their caregiving duties are the most likely to commit elder abuse against their own family members.

Effects of Elder Abuse

Seniors who experience abuse, even mild or modest abuse, have upwards of a 300% higher chance of death than those who are not abused. In addition, victims of elder abuse have higher levels of psychological distress and lower levels of self-esteem. Seniors who have been abused in nursing homes also tend to have more physical healthcare problems than elders who have not been abused, including joint and bone issues, digestive problems, chronic pain, high blood pressure, and heart problems.

October 23, 2014

Installing Video Surveillance in Nursing Home Rooms

One of the hottest debates currently happening in elder law and nursing home care is whether video cameras should be allowed in nursing home rooms. Many residents of nursing homes and their children believe that installing surveillance will benefit everyone involved; however, many nursing home facilities are attempting to block the installation of video cameras in their communities.

Nursing Homes Banning Use

The most common reason that nursing home facilities give to the children of residents about why video surveillance is not allowed is that the video recording violates federal privacy laws under the Health Insurance Portability and Accountability Act (HIPAA). However, that is not the case as long as the video cameras and recordings are owned by the families. Still, that reason remains commonplace for many nursing home providers.

New Video Surveillance Legislation

Illinois Attorney General Lisa Madigan has heard multiple complaints about the lack of accountability and ability to monitor residents in nursing homes. Her office has begun drafting legislation that would allow residents and their families to put cameras in the rooms of Illinois' 1,200+ nursing homes. The families of the residents would own and install the cameras; the facilities would not have access to them.

Ms. Madigan hopes that the law could be passed and implemented as soon as 2016. In Illinois, video cameras are not illegal in nursing home rooms, but the facilities can ban them. To protect the privacy of the residents, the resident or their healthcare proxy will have to request the cameras, and any roommates would also have to consent to their installation. The law would also require some type of notice to let people know that they are being recorded.

Four states: Texas, Oklahoma, New Mexico, and Washington all already have laws on the books that explicitly allow video cameras in nursing home rooms. With the passage of the law in Illinois, the hope is that other states will soon follow suit with their own laws allowing video cameras in nursing home facilities.

Benefits of Video Cameras

Deterring elder abuse in nursing home facilities is the main benefit that video camera advocates are arguing for the passage of these camera laws. When possible abusers know that they are being watched, most will behave properly. And if the cameras do not deter the abuse, it can at the very least provide proof of the crimes that can be admissible in court.

Another benefit of video cameras in nursing home rooms is that family members of the resident can monitor for inactivity on the part of the staff. Family members can ensure that their loved one is being turned to prevent bed sores, is being properly fed, and can ensure that all of their needs are being met.

Video cameras can also be valuable when patients have dementia or are otherwise unable to report mistreatment at the hands of the nursing home staff. However, elder law advocates remind family members that a camera is not a complete substitute for being there, communicating with staff, and seeing things with your own eyes.

October 20, 2014

The Average Lifespan Continues to Increase

According to the National Center on Health Statistics annual report, in 2012 the average life expectancy of our older U.S. citizens continued to increase. Seniors who reach the average of 65 can now expect to live another 19.3 years, an all-time high. Men on average live another 17.9 years, while women live an average 20.5 years after 65.

Life Expectancy Trends

The number inched up only slightly from 2011, and seniors gained an extra five weeks or so on average. However, the long-term trends of life expectancy have been dramatic. There has been a fairly substantial increase even over the last decade, let alone multiple decades past. In 1960, the average 65 year old America had another 14.4 years of life expectancy. Between 1970 and 1980, that number jumped to 16.5 years.

The life expectancy jumped to 17.3 years after the age of 65 in 1990 and 17.8 in 2000. But in the twelve years reported after that, the number has increased an entire year and a half. In addition, the disparities related to race and ethnicity has also narrowed. Statistics from 2011 show that among 65 year old seniors, life expectancy was 20.7 years for Hispanics, 19.2 years for Caucasians, and 18 years for African Americans.

Reasons for the Increase

The latest report points to some common causes for an increase in the average lifespan. Age-adjusted death rates have significantly declined for cancer, heart disease, stroke, respiratory disease, diabetes, flu and pneumonia. Even the rates of Alzheimer's disease have decreased, despite there being few effective treatments for the ailment. In fact, of the leading causes of death, the only one that showed any kind of increase was elderly suicide.

How Long will the Trend Continue?

Experts agree that it is impossible to predict how long the life expectancy rates will continue to increase before leveling off. Many people once believed that the average age would never top 80 years, but the report for 2012 puts the average expected lifespan now at 78.8 years old. As a result, those who were once naysayers have admitted that there seems to be no discernable reason why the average age shouldn't continue to climb.

Less smoking among the younger and middle aged could help increase the average lifespan in years to come. In addition, the levels of obesity in the U.S. seem to be leveling off. However, Alzheimer's disease, not even a top 15 cause of death in 1990, is now the sixth leading cause of death in the U.S. Experts are now debating whether the increase in Alzheimer's is simply a case of competing risks - now that the average lifespan is higher, there is a greater opportunity for seniors to develop the disease.

What This Means for Seniors

For some elderly people, the extra few years represent nothing but a bonus to spend with their family and loved ones. They have remained healthy or are coping well with their chronic illness or disability. In other cases, an extended lifespan is not necessarily welcome for some seniors who are dealing poorly with their health and are still around only because of medical intervention.

Many people whose love ones are part of the latter group can often be frustrated at the sight of the slow decline and don't know where to turn. The authors of this latest report understand and realize that as a society we have never been this old before, and caregiving will have to change with it accordingly.

October 15, 2014

Extendicare to Pay $38 Million in Medicare, Medicaid Settlement

A U.S. nursing home chain has agreed to pay $38 million in a settlement to end a federal government investigation into whether its nursing homes billed Medicare and Medicaid for poor care for its elderly residents. The settlement was specifically with a subsidiary of Extendicare Inc., Extendicare Health Services.

Extendicare Nursing Homes

The investigation focused on 33 of the company's nursing home facilities in eight states: Ohio, Pennsylvania, Wisconsin, Indiana, Kentucky, Michigan, Minnesota, and Washington. Extendicare provides post-acute and long-term senior care services. The company has in total 251 different care facilities across the country and the capacity to care for 27,600 residents. It is the seventh largest nursing home chain in the country.

Nursing Home Allegations

The Justice Department claimed that Extendicare understaffed its nursing homes, alleging in some instances of improper catheter care in addition to failure to follow proper procedures that led to falls and bed sores. The company was also under investigation for improper billing of Medicare and Medicaid for things like physical therapy and other senior services.

The care at some of Extendicare's facilities was so inadequate that some patients became dehydrated and malnourished. They developed infections that led to unnecessary hospitalizations. The company also inflated the number of residents receiving physical therapy and other services in order to bill more to Medicare.

Nursing Home Settlement

According to the U.S. Justice Department, the company has denied any wrongdoing in its billing practices or care of its residents. It agreed to the settlement on the condition that there was no admission of wrongdoing, and the company agreed to be subject to a compliance program that would monitor its residents' care.

The compliance program is a five year corporate integrity agreement. It requires an independent monitor to check staffing levels and other quality measures to ensure the level of care that its residents are receiving. The agreement applies to every facility owned by Extendicare, not just the 33 sites that were the subject of the investigation.

A lawyer from the Justice Department's civil division went on record as saying that Extendicare's program between 2007 and 2013 was driven more by profit and less by quality of care. As a result of the $38 million, two whistleblowers from inside Extendicare's company will receive awards. One person will be getting $1.8 million and the other over $250,000.

Other Cases of Nursing Home Negligence

This is not the first time that a nursing home company has been accused of fraudulent or negligent practices with their residents. In 2012, the federal government agreed to a $48 million settlement with the nursing home chain Ensign Group due to exaggerated billing to Medicare and Medicaid.

Advocates for nursing home residents have criticized the federal government for failure to look into other claims of negligence and abuse in nursing home facilities. Officials stated that they are planning on investigating more claims of nursing home negligence and would use the False Claims Act to do so. In the case of Extendicare, the government stated that the quality of care was so substandard or nonexistent in some of their facilities that Medicare and Medicaid should not have to reimburse them.