Articles Posted in Long Term Care Planning

End of life planning can be a very daunting task and is one many individuals do not want to face, however, actively addressing any future healthcare scenarios or issues in the event you are no longer fully capable, can save all parties involved from making painful or difficult decisions during emotional times. When thinking about the possibility of future incapacitation, it is important to know the different estate planning tools available in order to be adequately educated on your power to assign an agent to act on your behalf.

Health Care Proxy & Their Influence

When determining what your wishes would be in the event you are no longer able to make your own medical decisions, whether due to incapacity or illness, electing a healthcare proxy will help ensure that the decisions you made prior to incapacitation are honored. A healthcare proxy is an established health care agent named by you, as recognized under New York law, that can make healthcare decisions for you ONLY upon incapacitation, whether that incapacitation is temporary or permanent. Health care proxies are one of a few types of advance directives; it is also worthwhile to consider making a living will and filling out a Do Not Resuscitate Order. Assigning a healthcare proxy as well as making a living will ensures you not only have someone to carry out your wishes, but also have a way to notify loved ones about the decisions you have made for the end of your life.  

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.

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 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.

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 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.

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.

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:

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.

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;

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