New York Elder Law Attorney Blog

America is at the beginning of what many have deemed a "demographic crisis" with tens of millions of Baby Boomers nearing retirement. Older community members have many different needs than younger residents, and many areas remain unprepared to meet those needs. Our New York elder law attorneys have spent decades working with residents on an individual level to help them plan for their long-term financial and healthcare needs. However, besides individual residents creating their own elder care plans, many advocates understand that preparation also needs to be conducted at the societal level to account for the changing character of the community.

This week Big Think explained a new World Health Organization initiative to encourage "age-friendly" urban zones that better integrate seniors into community life. New York City was spurred by the call and recently launched an effort known as the Age-Friendly NYC Initiative. In fact, the first "Aging Improving District" opened this month in Harlem. These districts are intended to complement traditional Business Improvement Districts and tap into the community resources of aging citizens. Advocates explain that the goal is to change the current impression of seniors as an economic burden on government into one where seniors are considered an economic asset that can contribute to a more vibrant society.

The initiative's proponents explain that "the aging of America is a deep structural problem that requires big-picture thinking from social innovators." Proper integration of seniors into community life requires consideration about all aspects of life, from transportation to housing. For example, in Harlem's new Aging Improvement District, local businesses are changing shelving and signage, libraries are changing their hours, and other adaptations are being made all with an eye toward the needs of seniors. Much attention is also being given to a new housing option known as "MedCottage." These are modular homes for the elderly that can be hooked up to the home of a younger caregiver--often an adult child. It is hoped that new ways to care for seniors at home will reduce the strain on medical facilities.

It is encouraging that local New York elder care initiatives like Age-Friendly NYC have buy-in from area leaders like the Mayor's Office, New York City Council, and New York Academy of Medicine. Yet, as encouraging as these steps are, it is clear that local residents cannot rely on public efforts alone to account for their personal needs. All community members should take steps as early as possible to plan for their long-term financial and medical futures by visiting a New York elder law estate planning attorney.

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Many community members visit our New York elder law attorneys to ensure that they will have the financial resources necessary to obtain appropriate senior care when the time comes. Unfortunately, without prior preparation many local residents are not able to acquire high-quality assistance to maintain their preferred quality of life as they age. This weekend the Carroll Gardens Patch interviewed Assemblywoman Joan Millman about these and similar struggles that many area seniors face.

Assemblywoman Millman was recently appointed the new Chairperson of the New York Assembly Committee on Aging. She explained how her role requires her to be a funding advocate, because there are significant financial questions when it comes to state aid to help area seniors. She described how "they threaten every year to close centers, and that's of real concern to the seniors who use them."

Besides working to provide as many resources as possible to help area seniors, the Assemblywoman mentioned that she also works to raise awareness about the prevalence of New York elder abuse. She explained how the abuse includes both physical acts as well as financial exploitation. Consumer Reports recently noted that elderly financial abuse affects as many as one million seniors every year. Often the abuse is perpetrated by family members or close friends who take advantage of vulnerabilities for their own gain. As Assemblywoman Millman shared, "we get cases in this office where a son and daughter-in-law convince the mother to sign over the brownstone to them, and now the woman is convinced the daughter is going to sell the house from under her and now she doesn't have any place to live."

One of the main problems with catching cases of this abuse is the reluctance of many victims to come forward. She explained how many seniors feel that "there's so much shame and embarrassment, they can't tell anybody. Because how do you tell somebody that your own child is stealing from you or threatens you."

There remains far too little awareness of elder abuse and neglect in our area. While law enforcement officials are working on the problem, quite frequently wrongdoers are never held accountable for their conduct. One of the best ways for community members to ensure that they do not fall victim to abuse and neglect is to put a New York elder care plan in place to have access to the quality assistance when necessary. Preparation is often the difference between having a choice of acceptable living options and being forced into a mediocre facility. In addition, by contacting a local elder law estate planning attorney, residents will know that trained professionals are aware of their monetary situation which may prevent possible elder financial abuse or exploitation.

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Demand for retirement communities, assisted-living facilities, and nursing homes is likely to balloon in the next two decades. During that time the number of Americans over the age of 65 is expected to double. Current projections predict that there will be more than 71 million seniors nationwide by 2030. Through work with local community members our New York elder law attorneys know that every day thousands and thousands more seniors are taking steps to plan for their long-term future. A key consideration in that elder care planning includes figuring out where one might want to live down the road.

However, many might be surprised to learn that New York currently has the fewest number of housing units geared toward seniors relative to our total number of households. The National Investment Center for the Seniors Housing and Care Industry reports that when compared to all other metro markets in the country New York continues to struggle the most in providing senior housing to keep pace with the aging demographics.

On Tuesday the New York Times reported on a few area development teams that are now trying to fill that void. When the housing market collapsed, the construction of new projects geared toward seniors ground to a halt. The largest companies in the industry were hardest hit by the recession leading one industry analyst to explain that things were "pretty much at an all-time low. There's not much coming in the pipeline at all." However, the smaller regional operations that have survived have a bit brighter outlook with one developer noting, "it's a great time to develop senior housing...it's an opportunity and there isn't a lot of competition."

Fortunately, lenders are slowly loosening up their restrictions and allowing developers to get back to work on assisted-living properties. For example, a $35 million Long Island property just opened in March to overwhelming demand. A $150 million 404-unit retirement community in East Meadow has already sold virtually all its units even though it will not open for months.

While the new construction is encouraging, the uptick is happening slowly. There will be no stopping the tidal wave of seniors in the coming years who will want these housing options, and it is unlikely that the current building will be enough to meet that demand. That disconnect will likely increase the importance for area seniors to create a New York elder care plan ahead of time. Our local elder law estate planning lawyers encourage residents to practice prudence in these uncertain times and ensure that housing options will be available to them if they need it.

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This weekend the Times Herald-Record published a story written by one of our New York elder law estate planning attorneys, Bonnie Kraham, Esq. The article sheds light on the process of applying for Medicaid--the joint federal and state program that can pay for long-term care costs. It explains how there are actually two forms of Medicaid: Community Medicaid and Chronic Care Medicaid. Community Medicaid is targeted at those who require care at home. To apply for this form of care various documents must be provided such as three months of financial material, proof of income, past tax returns, and various other "common documents." A successful applicant can then keep a set monthly income with the remainder going to contribute to the care. Also, a single applicant can usually only keep about $14,000 in assets while a couple may keep $20,000. Local residents can consider visiting a New York elder law attorney to look at the possibility of using a "pooled" trust or Supplemental Needs Trust to keep more monthly income.

The second form of Medicaid is commonly known as Nursing Home Medicaid. It requires a more extensive application process. For one thing, financial statements for the past five years must be provided--this is known as the "five year look back period." Department of Social Services (DSS) investigators will examine financial transactions from that period to determine if any gifts were made which could have been used to pay for this care. If they are found then a penalty period may be imposed during which time the applicant will not be eligible for Medicaid. In addition, DSS investigators will examine IRS reports from the past five years, DMV reports, and financial institution documentation. This is all in an effort to ensure that the applicant is not attempting to hide any assets. Fraud charges may be brought if the DSS investigators believe that an applicant has engaged in deceptive practices.

Unlike with Community Medicaid, a single individual on Medicaid in a nursing home is essentially required to pay all of their income to the facility. If the individual has a spouse living at home then the spouse is allowed to keep about $3,000 a month in income. There are also limits on the amount of assets that the applicant is allowed to keep. However, legal strategies can be used to substantially increase the amount of assets that a family can save while still qualifying. The Medicaid Asset Protection Trust is one of the most useful ways to protect assets from Medicaid costs.

Many Medicaid applicants have problems with the process when they attempt to go it alone without the assistance of an elder law attorney. The complex documentation requirements and intensive investigation rules often result in an official hearing being called to resolve the matter. This is a stressful and time-consuming process that can be avoided by having professional help.

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The current high cost of nursing home care makes it important for residents to plan ahead to determine how they will pay for these services. In fact, with nearly 75% of local residents over 65 years old likely to need long-term care at some point, creating an elder care plan is becoming a virtual necessity. Nursing home costs in our state are consistently near the most expensive in the entire country, and so many community members visit our New York elder law attorneys to learn about their options to prepare for this expensive care.

According to an article in yesterday's Smart Money, recent federal cuts to many long-term care facilities throughout the country may result in even higher nursing home costs. The possible increases are linked to a decision from the Centers for Medicare and Medicaid Services (CMS) which announced late last month that it will begin cutting reimbursement rates to these facilities by 11.1%. CMS officials explained that the step was necessary to make up for a $4 billion shortfall last year. This reimbursement reduction will take place beginning in October. Many observers believe that the change will indirectly pressure many of these facilities to increase the cost on residents to make up for the shortfall. The CMS cost-cutting measure has spooked already jittery investors who worry that their profits will shrink as a result of the change. Even before this announcement the cost of local nursing home care increased 5% this year from last year.

Unfortunately, some also suggest that even with the price increase, services at these homes will likely be cut. Medicare payments are responsible for 20% of revenues for the average nursing home. Considering that many of these facilities are run by public companies with shareholders, there will be strong pressure to cut costs in any way possible to make up for the revenue reduction. Many fear that nursing home quality will be affected.

No matter what happens it is important to remember that nursing home residents can always seek to negotiate for extra amenities or a room upgrade. Public websites like Medicare.gov are a helpful starting point to compare nursing home costs and features. Residents in our area should also be aware that with proper New York elder planning they can take steps to ensure that they have the resources necessary to avoid nursing homes altogether and receive care in their own homes. In addition, if a condition arises where a nursing home stay is unavoidable, a proper elder law plan can ensure that assets built up over a lifetime are not spent paying for the staggering cost of this care.

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It is often emotionally wrenching to come to the realization that your aging loved one is in need of extra day-to-day care. For local residents, if a proper New York elder care plan is in place there should be options available to provide the necessary assistance. In many cases aid can be provided to the senior while they remain in their own home with care workers traveling to them to assist with basic living chores and some medical needs.

However, there may come a time when moving the relative into a long-term care facility is unavoidable. When that time comes there are often two major questions to answer: how will we pay for nursing home care and how do we know what facility is best? Local community members can receive guidance on the first question by visiting a New York elder care attorney. Even if no prior planning has been conducted to save assets from these costs--such as the creation of a Medicaid Asset Protection Trust--there may be options to protect part of one's assets while on the nursing home doorstep. This is known as the "gift and loan" strategy; it is an advanced elder law technique that can save some of your relative's nest egg from being spent down to pay for an extended nursing home stay.

This week Penn Live shared some tips to help families decide on the appropriate facility for their loved one once the financial issues have been resolved. Some assisted-living facilities are geared toward seniors who can do some things on their own (like bathing and dressing), while many other nursing homes provide assistance in virtually all tasks. In our area, the New York State Office for the Aging provides helpful information on various housing options for seniors and the specific services that they usually provide.

Elder care experts suggest that family members pay close attention to differences at potential homes when narrowing down the exact facility for your loved one. For example, easy access for frequent visits is a key consideration, so the nursing home's proximity to friends and family is important. In addition, when visiting a possible facility it is helpful to keep a close eye on the physical appearance of the home and the staff members. Nursing homes that are attractive, well-lit, and hazard-free are usually superior. Employees who are courteous, respectful, and appear happy about their work are much more likely to provide the care that your loved one deserves. Other considerations should also be investigated such as the activities provided by the facility, the religious and cultural support offered, and dining options.

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Every New York elder law estate plan should likely include a Power of Attorney and Health Care Proxy. These documents allow another person to handle a variety of legal, financial, and medical affairs on your behalf in the event of disability. Our New York elder law attorneys know that preparing for all possible contingencies is the main purpose of this planning, and so inclusion of these documents remains essential.

Some residents are less familiar with the importance of these decision-making tools and may assume them to be unnecessary in their particular case. They may believe that their friends or family members will step up and handle affairs appropriately without the need for formal legal documents. Unfortunately, that assessment is misguided because very often family disagreement arises among these individuals under the stress of dealing with the disability--setting the stage for conflict without prior delegation of decision-making power. The director of a local public aging services center explained that "the last thing you want is if you age and lose capacity, to become a pod in a power struggle between your kids or your grandkids." On top that, even if one's family members do not disagree on any financial or medical issue, the law will not automatically grant these powers to a certain friend or family member. In many cases, the disability requires court intervention to appoint a guardian which is a situation that should always be avoided.

Failure to provide this legal clarity ahead of time can have wide ranging effects. For example, KFBB News reported late last week on one man who is facing felony kidnapping charges after allegedly taking his 92-year old mother out of her long-term care facility and bringing her into another state without permission. The man was not his mother's Power of Attorney. The family was confused about the local elder care laws, and the man assumed he had the right to move his mother. He didn't. He is now awaiting extradition to face possible criminal sanctions for his conduct. It is likely that the man would not be facing any charges at all had a Power of Attorney been drafted.

While kidnapping charges in these circumstances are rare, all families have much to gain from ensuring that there will not be legal confusion in the event of a disability. In addition, it is important to have professional help with the creation of these legal documents. Experienced attorneys can explain what specific powers are useful to include. These are powers that otherwise might be forgotten and left out, such as the right to change beneficiaries on IRA's, annuities, and insurance policies, to create a trust, or make gifts.

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Over the years the core purpose of our New York elder law estate planning attorneys has remained unchanged--helping residents pass on assets at death, avoid probate, save on estate taxes, and plan for disability. Yet, technology changes have influenced some ancillary aspects of the preparation and senior care process. For example, on the estate planning side, new web applications now claim to offer non-legal services to digitally store important passwords to be released upon death or to help a family set-up an online auction to distribute family heirlooms. Even New York elder care has been affected by online and web-based tools that seek to expand living options for area seniors.

Much of this new technology has centered on keeping seniors out of a nursing home. This is not surprising as an average stay in an area nursing home is around $120,000 a year, and the vast majority of residents would much prefer to live in their own home for as long as they can anyway. One of the main reasons why many seniors are forced to move into one of these facilities is the need for around the clock observation in case something happens while they are alone. For the last twenty-five years this at-home observation need was essentially filled by a single product--the Life Alert Emergency Response System. The company still dominates the market by providing seniors with a permanent connection to emergency help that they can access via a button on a lanyard worn around their wrist or neck.

Reuters recently discussed how the emergence of web-based systems on phones and tablets have dramatically increased the options available to provide extra security to at-home seniors beyond Life Alert. For example, some seniors are using the "Life360" phone application to immediately send a message and GPS coordinates to family members at the touch of a button on their phone. A more comprehensive service--Sonamba--utilizes a tablet (like an iPad) equipped with a webcam and motion sensors. The device sends signals to family members when a senior's schedule seems irregular, gives medicine reminders, and allows the quick submission of messages.

Local residents interested in supplementing their New York elder care plan with emerging high-tech forms of aid have other options as well. Reflections Solutions offers a watch for seniors that monitors heart rate, temperature, and motion--automatically sending an alert when it suspects that a senior has fallen. Other monitoring companies even provide services to consolidate medical bills and records, set medicine reminders, and provide advisories for in-home care providers who visit the home.

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Nursing homes are generally the most expensive senior care option. For many area residents they are also living spaces of last resort--most would elect an alternative if available. Unfortunately, nonprofit organizations and businesses that work in the senior care field are still playing catch-up when it comes to building and maintaining alternative living options for the elderly. Assisted-living centers are growing in popularity, but a majority of area residents who need extra care continue to live in traditional nursing homes. The difference-maker is often whether or not the local resident has conducted any New York elder care planning.

Recently, the Star Tribune interviewed an executive from a company that is trying to develop more nursing home alternatives. Steve Ordahl, the vice president for business for the nonprofit senior care company Ecumen explained the benefits of their assisted-living centers and the requirements for those seeking to live in one of these facilities. The executive reported that since 2003 traditional nursing homes have shifted from 80% of its revenue to 50%, with alternative living options making up the difference.

New York elder care experts have found time and again that seniors report the most satisfaction with living situations that provide them with the most independence. Assisted-living facilities take that reality to heart and work to create an actual community environment that avoids paternalistic oversight. Independence is a focal point of these centers, so community members can wake up at their own time and eat on their own schedule. The Ecumen executive explained that they are committed to maximizing physical, spiritual, and financial wellness. Programming at these facilities goes well beyond afternoon bingo. These assisted-living communities sponsor museum trips and each building has its own in-house theater. Residents are free to leave these homes at any time. However turnover rates are quite low, because resident satisfaction rates are high. That is why most of these facilities are at full capacity.

Many residents believe that senior community homes such as those run by Ecumen are only attainable for the wealthiest seniors. However, one need not have endless resources to be able to move into one of these assisted-living facilities. The costs are actually less than many nursing homes. The only thing that usually is required is planning. For example, Mr. Ordahl explains that they seek pricing similarity with market-rate housing. Each facility also has an allowance for those who will eventually spend down their assets and qualify for Medicaid, though all those who move in must prove that they can privately pay for at least 24 months of care. It is therefore vital for residents to plan ahead. Our New York elder law attorneys have helped many clients put plans into place to ensure that they will be in a position to move an assisted-living facility if they choose down the road.

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Paying for long-term healthcare is often a challenge for area residents. This is true now more than ever as the nation continues to experience economic struggles and community members are forced to find ways to use their dwindling nest egg to cover their needs. For many residents, taking the time to conduct New York long-term care planning is the difference between staying in one's own home, living in a private nursing home room, or being forced into a substandard facility.

Even though many families have fewer resources now than in the past, the cost of long-term care continues to rise. Genworth recently published the results of the most comprehensive cost of long-term care survey ever. The research involved over 15,500 homes from across the country with data provided by more than 53,000 care providers in more than 384 U.S. Metropolitan Statistical Areas.

The latest figures indicate that facility-based services are more expensive than ever, showing a roughly 4.35 percent compound growth rate over the last six years. As has historically been the case, New York remains one of the five most expensive areas in the country when it comes to long-term care. An average private room at a nursing home costs residents in our area about $120,000 a year. This figure is nearly $43,000 more per year than the national average. That means that the average daily rate for these facilities is about $330, with some facilities charging nearly $675 per day to care for seniors. These figures do not represent the most extravagant or luxurious accommodations but basic rooms and services. Nicer accommodations and more advanced medical assistance often increases that total significantly. In fact, these costs usually increase if a senior develops a disabling disease later in life, such as Alzheimer's. Unfortunately, fears of developing Alzheimer's are not unfounded as nearly one in eight Americans age 65+ and half of those aged 85+ have the disease. Considering that many seniors may require five, ten, or more years in these facilities, the total cost of long-term care can be staggering.

With costs of this nature, it is imperative that local residents act early to makeNew York long-term care preparations. Contrary to some misperceptions, Medicare generally does not provide federal assistance for long-term care. Medicaid may pay for necessary care, but it first requires an individual to use most of their own assets before qualifying. The use of a Medicaid Asset Protection Trust can help a senior to protect their assets for their children and qualify for Medicaid benefits without the requirement to "spend down" one's assets. Long-term care insurance is usually a superior method of preparing for these costs.

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Many seniors consider their pets to be part of their family. The companionship that an animal brings is often particularly important for those who have lost their spouse or who live alone. In fact, the Center for Disease Control and Prevention specifically credits pets with decreasing blood pressure, increasing socialization opportunities, and providing exercise for owners. New research out of Miami University of Ohio and St. Louis University found that pet owners were more physically fit and less fearful of basic daily stresses than those without animals.

The unique connection between owners and their animals is one of the key reasons that our state allows residents to create a New York pet trust as part of their estate plan to pass along resources for the care of their animals. In addition, senior pet owners can now receive varying degrees of assistance to help care for their animals in their golden years. Proper pet care is often daunting for seniors who struggle to get their animal to and from the vet, provide regular walks, and similar tasks. In the past, residents were often forced to give up their beloved animals when they were no longer able to provide them the care they needed on their own.

Fortunately, as Global Animal discussed in an article this morning, various services are now available to help senior pet owners keep their pets in their own home. For example, pet sitters are prevalent in most cities to help walk dogs, administer medication, and perform other aid. Many of these sitters double as veterinary technicians so they are often trained to catch animal illness that may not be noticed by the pet owner.

Similarly, some veterinarians actually make house calls for owners who have difficulty getting to the physical animal hospital. One veterinarian who performs such calls explained that visiting with an owner and animal in the home actually makes it easier for the professional to understand the animal's lifestyle and provide suggestions for improving their health. The veterinarian noted that she believes seniors and their pets have a bond that other family members often don't recognize. Her work making home visits is specifically geared to keeping that bond alive.

New York elder law estate planning involves preparations to keep community members in their preferred lifestyle for as long as possible. Part of that planning process may include ways for seniors to maintain their close connection with their animals. As one veterinarian at an animal clinic that caters to senior clients explained, "The last thing you want to do is take pets away. People live longer when they are around animals and are happier when they have that bond."

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Many area residents visit our New York elder law attorneys because they seek to keep their preferred way of life as they age. Almost everyone will need some extra assistance with tasks as they grow older. Many options are available to provide that needed care without major disruptions in a senior's life. However, those services come at a cost. At-home care and flexible forms of long-term living facilities are often out of reach for community members who have not conducted prior planning to account for those costs.

Elder care advocates have repeatedly emphasized that seniors report the most satisfaction with their quality of life when they are able to stay in their own home as they age. Moving into a nursing home is therefore a "last line of defense"--most other methods of senior living are preferable. Not surprisingly, at-home care services have grown in popularity in recent years. The National Association for Home and Hospice Care reports that about 12 million people receive home health care nationwide each day.

The benefits of this care led many states to create programs providing at-home services in an effort to keep seniors out of more intrusive nursing facilities. Unfortunately, budget strains across the country have led many areas to drastically cut the public funding of home health services. The Associated Press noted this week that three out of four states have reduced aging and disability services over the past two years alone. For example, many areas have slashed the amount of time that nurses can spend making house calls, have ended meal deliveries, and cut senior day care programs. The cuts have thrown a wrench into many elder care plans by eliminating public assistance that some had come to rely on.

The story is no different in our area. The latest New York state budget made similar painful cuts that slashed publicly funded at-home care services for seniors. The Home Care Association of New York State reports that since 2008 there have been $434 million in state cuts to home and community-based care. Upwards of 80% of long-term home health care providers in our area are currently operating in the red. Barring some change, many of those providers will likely be forced to shut their doors in the near future. The stark situation suggests that all area residents need to take matters into their own hands. It is now more important than ever to conduct New York elder care planning as early as possible to ensure that the resources are available to maintain one's lifestyle whenever extra care is needed.

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