Articles Posted in Long Term Care Planning

Rather extraordinary claims were recently made by researchers in a Nature Medicine article that may forever change the long-term care planning landscape.

Scientists from Georgetown University are claiming to have developed a blood test that can determine whether an individual will develop dementia symptoms within two or three years. Their findings suggest the test is 90% accurate. While few are questioning the researchers methods, it is still to early to know if the results will hold up in future studies. This initial group consisted of only 525 total participants (all over age 70), with only 28 of that group ultimately developing symptoms. More efforts are already underway to test larger groups and potentially verify the results.

While this test offers nothing in the way of a direct cure to prevent Alzheimer’s or minimize symptoms, it still may eventually lead to treatments. That is because some research argues that all previously attempted therapies failed because they were only begun after someone showed the symptoms–at which point it may have been too late. However, if this test proves accurate, then treatments can begin earlier that may actually be effective.

Long-Term Care Insurance
Beyond the specific medical importance of the testing, the ability to detect dementia years in advance can have significant effects on planning. That is because having a better idea of challenges that you may face in the future can be reflected in the specific steps taken to prepare for long-term care.

Last week, for example, Forbes published a story that suggested screening for Alzheimer’s may drastically change the way long-term care insurance is priced and/or used. That is because the insurance is based on the uncertainty of the future. All residents are advised to use long-term care insurance to ensure that support will be available, even if they end up not needing it. The costs of long-term care insurance can already be high for some (particularly for those who do not purchase it while relatively young and healthy).

But if individuals know in advance what their future is likely to hold, then it may be far harder to find affordable insurance. This is the same general problem as the ‘pre-existing condition’ issue that affected traditional health insurance.

These early advances only allow detection a few years out, and so it may not affect most long-term care insurance purchasers who do so (ideally) many years or decades before needing coverage. However, as the science advances and diagnosis occurs far earlier, then it is possible for these tests to fundamentally alter insurance and planning.

For help putting a long-term care plan in place throughout New York please contact our legal team today.

Elder care advocates are understandably up in arms following reports about questionable evictions from a Brooklyn facility catering to seniors. The sad situation is a reminder of the continuing struggles faced by so many local families in their quest for quality, reliable long-term care and support. It is also a troublesome sign that most communities remain drastically unprepared to provide the aid that will be needed in coming decades as the New York population ages.

NY Nursing Residents Evicted After Facility Closure
As reported by the NY Daily News last month, a group of over 100 Brooklyn seniors are currently scrambling to find alternative living arrangements following the announcement of the sudden closure of the Prospect Park Residence. The Park Slope facility has been a home for senior for over 15 years. But that will end in May, as the facility is slated to shut its door by the beginning of June.

The news was apparently a shock to residents, their family members, and even employees of the facility. The nursing home’s owner explained that finances were the cause of the closure, citing inadequate compensation and tax increases. Perhaps contributing to the closure were other caregiving problems faced by the home in recent years. A 2010 lawsuit claimed that the facility’s poor care led to a resident death. Just last year, another suit claimed that the facility was improperly licensed and that negligence led to at least three deaths of residents with dementia.

Public Outcry
As soon as news of the sudden closure was made public, there was a local outcry. Several area elected officials issued a joint statement slamming the move as “cruel, heartless, and unacceptable.”

The Capital later reported that the evictions recently caught the eye of the New York Attorney General who is “engaged” in the matter, presumably to find a solution. Attorney General Schneiderman explained, “It is very hard to argue that it is reasonable conduct to tell vulnerable seniors you have 90 days to get out of your home.”

Despite the clear public engagement on the issue, it remains unknown whether there is any alternative to closing the facility. In fact, the NY Department of Health already approved the closure plan.

As the seniors living at the Prospect Park Residence learned all too harshly, the future is never certain. While taking time to plan ahead for that uncertainty can never eliminate all risk, preparation does go a long way. Contact our elder law estate planning attorneys today to see how we can help provide peace of mind.

The face of New York nursing home care has been changing in recent years. The traditional model of individual counties throughout the state owning and operating facilities to provide care to ailing seniors is being phased out in may places. Instead, the counties are selling the homes to private companies to operate. The moves are spurred in almost all cases by financial realities–the facilities are too expensive for the county to operate.

Understandably, elder advocates worry about the effect of the change on senior care. In the past, some analyses have suggested that privately-run nursing homes, on average, show more “deficiencies” than their public counterparts. The assumption is that private homes are motivated by profit and more willing to cut resources to residents and refuse to pay wages for the best caregivers in order to boost their bottom line.

But is is important to remember that no two homes are identical, and “averages” do not mean that all privately run homes are rampant with neglect and need to be avoided. Early reports out of Ulster County, for example, offer a hopeful reminder that quality decreases may not automatically follow private nursing homes sales.

So Far, So Good
As reported by the Oneida Dispatch, many residents of the Golden Hill Health Care Facility are happy with the operation at the facility since it was sold to a private company six months ago. The head of the Residents’ Council explained that, since the change, more staff members had been hired, including physical and occupational therapists. In addition, the resident suggested that other aspects of the operations, from the food to building cleanliness, had improved since the take-over. According to the most recent state on-site review of the home (in September) the facility was in full compliance with state and federal caregiving requirements.

There was aggressive push-back when the county board was debating the sale in 2011 and 2012, based mostly on concerns about potential decrease in quality of care. Advocates for the county-employees at the facility argue that it is still too early to tell whether the long-term care at the facility will be affected by the change.

It is impossible to draw general conclusions about care quality from a single New York nursing home. But this situation is a helpful reminder of the fact that quality varies considerably from facility to facility. Not all private homes are bad, and not all public facilities are superior. Those making choices are urged to be diligent in reviewing their caregiving options.

Get Help
If you have questions about selecting a nursing home or applying for Medicaid in New York in order to pay for nursing home care, please contact our elder law attorneys today to see how we can help.

The aging process is never easy–for the senior or their family. Thoughts of mortality aside, the challenge of dealing with the day to day vulnerabilities of elderly friends and family is something that is impossible to fully appreciate until you experience it first-hand. From figuring out how to get groceries, doing to the laundry, emptying the dishwasher, and countless other tasks, seniors who are facing physical and mental decline connected to their age have a myriad of daily struggles.

One of the most acute challenges faced by aging New Yorkers relates to driving. It is easy to forget how much one relies on driving until the privilege is taken away. Considering the importance of driving, it is little wonder than most seniors do everything they can to keep their traveling options open, even when their frailties make it unsafe. Friends and family members of New York seniors must be prudent about monitoring this risk and stepping in when necessary.

Senior Driving Fact Sheet
The U.S. Centers for Disease Control and Prevention compiled a fact sheet that highlights the problems faced by senior driving. It also offers some helpful tips that are worth perusing to help curb the problem.

Notably, federal data suggests that there are around 33 million daily drivers over the age of 65–this represents a nearly 25% increase over the last decade. This rise is alarming considering that the risk of being injured in an auto accident increases as one ages. As it now stands every single day around 15 seniors are killed and another 500 injured in car accidents. These are not inconsequential figures but instead represent an alarming problem that should be on the radar of all New York families with a senior driver.

Those examining the problem argue that these dangers are caused by two factors. First, seniors are slightly more likely to get into an accident in the first place as a result of vision problem, cognitive decline, and other vulnerabilities which general driving ability. Second, the elderly have weaker recovery systems and physical ailments which make it more likely that their body will be harmed even in relatively minor accidents.

To help, federal official urge seniors to have regular vision check-ups, work to ensure adequate physical strength, and attempt to travel only in the safest conditions. In addition, seniors should be particularly vigilant about basic habits like seat belt use, safe distance between vehicles, and more.

Our New York elder law attorneys urge all families to be aware of these driving risks–particularly in light of the added danger of winter driving in the next few months.

The changing face of New York nursing home care continued this weekend as another county officially got out of the elder care business. As reported by Syracuse News, the Van Duyn Home and Hospital was transferred by Onondaga County to the “Upstate Services Group” — a private company that owns at least eleven other New York elder care facilities.

This transition was in the works for quite some. The news report explains how the facility has long-been plagued by accusations of poor care on top of acting as a huge financial burden for the county itself. In fact, Van Duyn was under intense scrutiny from federal regulators for its poor caregiving track record. That is on top of more than a dozen private civil lawsuits filed by former residents and their family members against the county alleging negligence.

The financial issue combined with care quality concerns led many to suspect that the 500-bed facility would be shuttered. However, with this transition to private ownership, it appears the the facility is safe–at least for now. Interestingly, one of the main concerns with sales of public facilities to private companies is the risk of a decrease in quality for residents. However, in this case, because of Van Duyn’s poor track record in the past, there were less complaints of that nature.

But that is not to say that everyone is happy with the change. In order to make the facility more financially stable, the private company plans to cut employee benefits. It is unclear if or how such a move will affect the home’s ability to recruit and retain qualified caregivers. But union leaders were understandably angry at the switch, warning of negative ramifications as a result of the pension cuts and health benefit reductions.

One positive sign is that NY health department officials note that other homes owned by the same company receive high marks for care quality. Obviously the hope is that that track record bears out in this case.

This latest move in Syracuse is just another reminder of the trend away from publicly owned long-term care facilities in New York. The change is pushed by many demands and is itself just one part of new nationwide approaches to elder care. Nursing homes overall are falling out of fashion, as many seniors prefer to age in place and receive at-home support for as long as possible. For help understanding elder care options in your own case or that of a family member, consider contacting our NY elder law attorneys today.

Checking Facebook, updating Twitter, adding a quick blog. These tasks are becoming ubiquitous among all New Yorkers, including older residents. Social media is a critical part of many lives, and it is the primary way that some stay in touch with family, friends, and acquaintances. However, the medium has risen in popularity so quickly that many rules and customs about how to use these services have yet to develop. For that reason it is important to step back and ensure that you are following best practices when it comes to how you are sharing information via these web programs.

For example, last week Forbes published an interesting story that discusses some social media considerations unique to elder caregivers.

Most importantly, advocates are issuing a call for prudence and caution when posting information about the health and well-being of seniors. Privacy concerns should be considered carefully, particularly when discussing others who may not be able to consent to the information being made available to anyone online.

Unwanted Attention
The article authors explains the struggles she endured when others shared information about her father’s death online without her permission. She notes that within minutes of telling a friend about her father’s passing–while she was still in the very early stages of the grieving process–the friend made a comment about it on Facebook. That posting then spurred many other comments, private messages, and calls that only exacerbated the strain on the grieving daughter.

Of course there is a time and place for sharing sad news and healthcare updates. But in today’s hyper-connected world many fail to give careful thought to those details. This can lead to strained relationships and conflict. As the author explains, “All were well-meaning and sympathetic, but I could only feel anger at their intrusion, because at that moment, before I had even started grieving, my private pain had become public.”

To help others, three general “ground rules” are shared in the story that should guide elder caregivers and others in their social media etiquette. Those three rules are:

1) Before every post/message/tweet, remember that you may be speaking for others in addition to yourself.

2) Do not share information about others without their permission unless absolutely essential.

3) Consider whether your social media use is actually creating more isolation that eliminating.

The story extrapolates on these ideas, and so it it worth taking a look at the full story to learn more.

Many New Yorkers remain unfamiliar with the benefit and flexibility of using trusts to plan for the future and protect assets in the present. Trusts can prove useful for all residents, including most middle class families. In our work with estate planning, we often help set up basic living trusts which help avoid probate and streamline the inheritance process. On the elder law side, Medicaid Asset Protection Trusts are used to protect assets from the “spend down” requirement needed to qualify for Medicaid and secure necessary long-term care.

Beyond those two trusts, however, there are many other options that may prove useful depending on your specific situation. A LifeHealthPro article last week discussed a few “specialty” trusts. A review of the topic is a helpful way to get an idea of the true scope of trusts and the many different ways that they may be used to carry out very specific wishes.

For example, some of the trusts mentioned in the story include:

Incentive Trusts – One common concern regarding inheritances–particular large ones–is the effect that it may have on the one who receives it. Parents do not want children or grandchildren to lose their drive and ambition as a result of having a sizeable inheritance fall into their lap. To prevent that, an incentive trust can work by being dispensed to a beneficiary based on certain benchmarks. For example, the trust may only “match” an individual’s income, acting as a spur for them to improve their own annual salary. Alternatively, the trusts can be based on meeting certain life goals or other set points.

Travel Trusts – As the name implies, these trusts pass along assets that must be used for travel. For example, a family may have a rich heritage in another part of the country or the world, and a trust can be created specifically to ensure younger generations are able to visit that location at some point in their lives.

Heirloom Asset Trust – These trusts protect a specific asset from leaving the family. Whether it is a summer home, artwork, or other valuable and meaningful property, the trust can act as a safety net. Instead of simply giving the object to someone else and hoping it it not sold, this tool provides more certainty.

While many unique trusts are available, it is important to understand the potential ramifications of using each. An attorney can explain potential pitfalls in placing too many limits on how others can use trust funds down the road. There are no one-size-fits-all answers, but at the very least one must think critically through all scenarios before deciding on the best plan.

Many of us can relate to growing concerns over loved ones as they continue to age and require more assistance. It can be challenging to meet these changing needs while still recognizing that our elderly loved ones are capable of performing some tasks on their own. It may seem obvious that legal remedies exist for those addressing extreme issues brought up by dementia and other forms of degenerative disease in elderly family members, who may entirely depend on a third party for assistance with daily life activities. What may not be as obvious is that those solutions are legally available to help address our elderly loved one’s needs without necessarily having them declared incompetent, while also enabling them to utilize a proper degree of autonomy.

New York Law
New York Mental Hygiene Law Article 81 was enacted to provide those seeking guardianship, and the Courts, the opportunity of using the least restrictive means of intervention in order to meet the specific personal or property management needs of the elderly individual while still maintaining an appropriate level of independence based on their capabilities. Specifically, Section 81.02(a)(2) of the Article provides that the Court may appoint a guardian to provide for the personal or financial needs of a person without having them declared incompetent, so long as that person agrees to the appointment. This becomes especially relevant in those situations where an individual is just starting to exhibit the first signs or symptoms of a degenerative disease affecting their mental capacity.

Consider a situation in which an elderly woman lives with her daughter. She has recently been diagnosed as being in the early stages of Alzheimer’s disease, and experiences intermittent memory loss and confusion. While her personal affairs have remained relatively unaffected, she requires assistance in managing her finances. Article 81 gives her the ability to enlist and agree to the assistance of her daughter in addressing her financial affairs while allowing her to remain independent in other personal matters, such as food, shelter, clothing, health care, and safety. Her current needs are being met without her rights being overly restricted, and it is accomplished without the added requirement of the Court finding her to be incompetent. In this way, the law enables the Court to consider the wishes of the elderly person in making a decision which preserves their independence and allows for their participation in the legal process which will affect their affairs. The Court can modify the powers of the guardian later, when the elderly woman’s needs change in the later stages of her disease.

It is important to note that there are many less restrictive alternatives to guardianship that the Court must consider before appointing a guardian in any case. Contact our elder law estate planning attorneys today to discuss your options in meeting the needs of a loved one, and to see if guardianship is the best alternative for you.

Seniors in Continuing Care Communities in neighboring New Jersey are about to have many new ways to protect their rights and obtain better care. On Thursday, October 17, 2013, New Jersey Governor Chris Christie signed the “Bill of Rights for Continuing Care Retirement Community Residents in Independent Living (CCRC).” The bill covers a wide range of issues facing residents in CCRCs, including a resident’s entry into a facility, communication between the facility and the resident, financial issues, and termination of services. The bill also provides for penalties ranging from $250 to $50,000 for violations of the provisions of the bill.

The bill includes the following rights:

· Each resident will be treated with respect, courtesy, consideration, and dignity;
· Residents are permitted to see their own medical records, participate in their own medical decisions, refuse treatments, and determine their life support choices in advance;
· Each resident may file a complaint with an appropriate agency or State office without fear of retaliation from the facility;
· Facilities must keep records of all written complaints about residents’ rights, which must be available to residents as well as their family members, doctors, and the state;
· A resident may appoint a legal representative with a durable power of attorney to handle financial matters if the resident is unable to do so;
· Each resident is entitled to 30-days’ advance written notice prior to the increase of any fees;
· A resident shall have the right to have guests and visitors at the facility, and the right to allow guests to stay for a reasonable period of time in a guest apartment or unit in the facility, subject to reasonable policies and procedures of the facility;
· A resident may leave and return to their independent living unit at will, provided the resident informs the facility if they will be temporarily absent overnight, or for a longer period of time.

The bill also requires that each new prospective resident is provided information about the facility in the form of a disclosure statement and a written copy of the residents’ rights and responsibilities prior to signing an agreement. Additionally, each new resident will have the option to cancel the continuing care agreement within 30 days of signing, and the option to wait 30 days to occupy the new unit.

The Bill comes at a time when Continuing Care Retirement Communities and other assisted living facilities face increased scrutiny for elder abuse. In a national survey, New York received a failing grade in nursing home care and ranked 45th overall across the United States. Comparatively, New Jersey received a B.

For help learning about elder law issues in New York and putting plan in place to ensure proper long-term care, please contact our team of attorneys today.

You may remember that on New Year’s Day of this year, a large piece of legislation was passed by Congress and signed by President Obama. The bill was the one that (temporarily) avoided the fiscal cliff. It was the measure that seemed to permanently set the estate tax rates among other things.

At the same time, the legislation also called for the creation of a Long-Term Care Commission. Comprised of 15 members, selected by both Republican and Democratic leaders, the group was given six months to hold hearings, debate, discuss, and create a report on various issues regarding long-term care nationwide. More specifically, the entity’s specific charge was to “develop recommendations for the establishment, implementation, and financing of a comprehensive, coordinated, and high-quality system that ensures the availability of long-term services and supports for individuals who depend on this system to live full and healthy lives.”

The Recommendations
Last week the Commission officially ended its work and published its final report. You can view a full copy of that report in .pdf form here.

What does it say?

The report summarizes the challenges looming for policymakers as Baby Boomers age. Many familiar ideas are discussed, including the importance of at-home caregivers and the need for proper financial arrangements to pay for the care that will be needed.

In analyzing the report, the nation’s largest senior advocacy groups were somewhat guarded. For example, the AARP noted that “the Commission’s recommendations would move us in the right direction toward a more person- and family-centered long-term services and supports system. Regrettably, agreements on comprehensive long-term care financing could not be reached in the short time the Commission had to do its work, but AARP remains committed to seeking solutions to this critical issue. AARP at both the state and federal level also remains dedicated to re-balancing Medicaid services.”

In short, this report may be helpful in shaping the general issues and advocating for some changes which can improve the long-term outlook on this issue. However, observers concede that major issues related to financing were noticeably absent. This is yet another reminder of the need for individuals to do everything in their power to make financial arrangement for long-term care privately. Ideally, this would take the form of long-term care insurance built into an overall, comprehensive estate plan.

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