New York Elder Law Attorney Blog

This week the USA Today reminded readers of the role that family members play in catching the onset of cognitive mental diseases in seniors, such as dementia and Alzheimer's. As any New York elder law estate planning attorney can attest, these issues are of particular importance in the legal context because mental issues can affect one's legal capacity. The ability to conduct estate planning, receive New York Medicaid help, or otherwise make prudent decisions for the future will be made more difficult if begun after dementia or Alzheimer's has set in.

By the very nature of the condition, the one who is suffering from these issues has difficultly identifying the problem themselves. That is why a family plays a crucial role in identifying the cognition problem and addressing it. As the article notes, "dementia can sneak up on families. Its sufferers are pretty adept at covering lapses early on." Often it is not until there is some major accident or life-threatening complication that adult children, spouses, and others become fully aware of the problem.

To combat the challenges of early detection, experts are calling on family members to be more involved. As part of the first "National Alzheimer's Plan," advocates are trying to raise awareness about the need for relatives to be diligent about a senior's actions to ensure mental cognition issues are caught as soon as possible. One advocate noted, "family input should be mandatory...it's the only way to know if the person really is eating enough and taking her medicines as she claims, and not forgetting to turn off the stove."

In addition, there is a growing call for primary-care doctors to take a more active role in detecting dementia early. For example, in a regular visit the doctor might ask "How are you doing?" Usually the senior patient replies, "Fine," and then the matter is dropped. This minimal discussion of basic life circumstances is too brief for the physician to have any way to ensure that the senior's mental condition has not reached a dangerous level.

On top of that, as part of the early detection programs, government officials working on dementia and Alzheimer's issues are trying to get families to conduct advanced planning. Having a Power of Attorney and Health Care Proxy are crucial as soon as dementia is diagnosed. No one is fully prepared for the challenges that aging can bring--particularly conditions that attack the mind. No amount of financial preparation or long-term care plans can make the process easy. However, the overall stress of the situation is less taxing when steps have been taken ahead of time to ensure that sticky matters like estate preparation and proper long-term care planning are decided ahead of time.

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New York's passage of the same-sex marriage law last year was seen as an important step in ensuring fairness and equality for all residents. Of course, as each New York elder law estate planning attorney at our firm has explained, same-sex couples still have unique planning needs because their marriages in our state are not recognized at the federal level. This lack of recognition is mandated by the federal legislation passed in 1996 known as "The Defense of Marriage Act" (DOMA).

Several recent legal challenges have been mounted against DOMA, seeking to overturn part or all of the law on federal constitutional grounds. In fact, last February President Obama admitted that he considered the law unconstitutional and would no longer defend it in court. This led to much political consternation as various Congressional leaders who support DOMA sought ways to take up the defense.

Late last week, a federal judge in one of the cases challenging DOMA indicated that she is likely to strike down at least part of the law as unconstitutional. The issue in that case relates specifically to participation in long-term healthcare programs for state employees. Right now same-sex spouses and domestic partners of federal employees are denied the right to participate. Opponents of DOMA have argued that the government has no proper basis for the exclusion of these couples other than prejudice against gays and lesbians.
The judge agreed, noting that defenders of the law, "have failed to show a plausible, legitimate, rationale for excluding registered domestic partners from (the law's) list of eligible family members (for the tax benefits), and the court can think of none."

The judge in the case went on to note that statements made by supporters when enacting the ban in Congress indicate that it was motivated by "antipathy towards same-sex couples." Of course excluding same-sex partners from long-term healthcare assistance simply because of distaste for the couple is an unconstitutional overreach.

This particular case is a reminder that the challenges facing same-sex couples is not only related to estate planning but also elder care. Local same-sex couples have the same concerns about New York Medicaid assistance, long-term care insurance, and other senior issues. Lack of federal recognition of their unions has effects on strategies that are employed when it comes to these long-term care issues. That is why it remains essential for same-sex couples in our area to visit with a New York elder law attorney to ensure that they are well-positioned to receive the extra care they might need down the road.

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Advisor One reported his week on a push by a variety of national legal associations to support the "Older Americans Act of 2011." The Older Americans Act (OAA) was first passed over 45 years ago, in 1965, to support seniors nationwide with a range of community planning and social services. The Administration on Aging was established as part of the legislation. Many New York elder law attorneys have joined in the advocacy effort to reauthorize the bill. In fact, just this week the National Academy of Elder Law Attorneys (NAEL) announced their support for the measure. NAEL is a professional association of elder law attorneys that work with the elderly and those with special needs.

Over the years many advocates have come to appreciate the important role that the OAA plays in the lives of vulnerable seniors throughout the country. However, the law was set to expire in 2011. That is why Senator Bernie Sanders from Vermont proposed legislation which would reauthorize the Act. It is difficult t get anything passed through the gridlocked Congress these days. However, that has not stopped those supporting these important efforts from trying to get it through the system. Many elder law advocates believe that the reauthorization effort is actually gaining steam.

A separate bill--the Older American Act Amendments of 2012--would make a few important changes to the original measure. For one thing, it calls for a revision of the 'Experimental Price Index for the Elderly." This initiative would change the index so that it more accurately reflects the costs which impact seniors at this stage in their lives. Other changes include altering the definition of "economic security" as it applies to determinations for housing, transportation, and long-term care assistance. A Meals on Wheels program would also be established along with a senior center community planning grant program.

The President of NAELA recently issued a ringing endorsement of these measures. He explained, "Programs supported by the OAA help seniors live independently in their homes, while preventing taxpayers from having to pay for more expensive nursing homes, hospitals, and other health care services. [...] It's a win for everyone."

Besides NAELA, the bill is also supported by the American Bar Association (ABA). The ABA adopted a policy a year and a half ago noting their support for the reauthorization of the Older Americans Act. In issuing that policy the ABA explained that elder justice needed to be a concern of all Americans. It was noted that the delivery of legal services to the elderly community remains too low, and all measures which would enhance that availability should be promoted.

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Earlier this year a featured article in Atlanta Magazine offered a uniquely detailed and accurate portrait of what it is really like to help an ailing parent or loved one as their heath deteriorates. Entitled, "The Long Goodbye," the article shares the author's own story of heartbreak, worry, stress, financial loss, and confusion while caring for his ailing father. Each New York elder law attorney at our firm understands that it is often helpful to hear real, individual stories about the aging and caregiving process. Discussing numbers--assets saved, taxes avoided--is necessary, but at the end of the day this process is very much about emotions and family values.

The author explains that he thought his father was going to die in 2001. The elderly man had fallen while trying to get the mail, hitting his head hard on the ground and temporarily losing consciousness. The man then skinned his knees as he crawled back up his driveway to the front door of his house. It was that incident that prompted his family to take him to the hospital where he was diagnosed with a deteriorating spine. Not only that, but doctors also found prostate cancer. A risky operation was undertaken, and the family was warned that the man was likely in his final days.

However, he was not actually in his final days.

Similar to the experiences of many local community members, the elderly man persisted. For the next eleven years he was shuttled from care facilities, hospices, and other locations as those involved struggled to find the best fit for him. Our New York elder law attorneys have worked with many clients who have similarly been confused as to what long-term care options are best for their loved one.

The eleven years of care took its toll on the family finances. The author explained, "Daddy's long goodbye has drained his retirement income and life savings of more than $300,000. Where's the money gone? Assisted living, mostly. Of course, that amount doesn't account for his medical bills, most of which have been paid by Medicare and insurance policies that were part of his retirement."

The author admits that he and his sister were completely unprepared to deal with their father's deterioration. They were not familiar with long-term planning options, had not spoken with an elder law attorney, and did not know where to begin to get him the care he needed. The author warned others that while it may not be comfortable to talk about, the benefits of figuring some of these details out ahead of time is absolutely essential.

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The vast majority of residents receiving long-term care in nursing homes in our area participate in the New York Medicaid program. The program is a crucial state-federal effort that ensures seniors and the disabled have the access to life-saving, day-to-day care that they need. Recently, several influential federal officials have begun asking questions about one crucial aspect of the program: drug prescriptions. Essentially, the officials are focusing attention on the potentially excessive practices of some doctors in the program. The officials want to know if the alarmingly large amounts of drug prescriptions by some medical professionals are necessary (and safe) for the consumers who receive them.

Financial concerns are obviously involved in this particular investigation, but our New York Medicaid attorneys understand that this oversight can also be an important way to ensure that quality of care standards are met at these homes. For example, as discussed in a Pro Publica story published yesterday, many states, including New York, are being pressured to crack down on doctors who prescribe massive amounts of potentially dangerous drugs to seniors. The effort is being led by Senator Chuck Grassley who sent letters to three dozen states asking about efforts underway to investigate physicians who prescribed antipsychotic drugs and anti-anxiety painkillers with seemingly reckless abandon.

In the elder law context, these drugs have very real consequences for seniors. Nursing homes have long been known to provide antipsychotic medicine to residents for "off label" purposes in an effort to make the residents easier to control. However, recent studies have found that not only does this practice deprive seniors of the ability to be fully engaged in the world around them, but overmedication can be downright dangerous. There is actually a black box warning on antipsychotic medications explaining that use by a patient with dementia can lead to an increased risk of death. Yet, dementia patients still receive this medication in nursing homes across our area each day.

Now the Senator is hoping to crack down on the doctors who overprescribe these drugs. Unfortunately, a lot of work still needs to be done in this regard as most doctors face few punishments for prescribing large amounts of medications, even when they are unable to show that the prescription rates were necessary. Some doctors issued tens of thousands of prescriptions each year. For example, one physician wrote nearly 19,000 prescriptions for the antipsychotic drug Seroquel last year alone, totaling almost nine an hour for every hour of every workday.

In one bit of positive news, over the past few years New York was actually praised for cutting down on some of the most abusive practices. A few of the highest-prescribing physicians in our state who could not explain their actions have been kicked out of the Medicaid program--saving taxpayer dollars while keeping seniors safer.

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Yet another company, Northwestern Mutual, has recently issued a "Cost of Long-Term Care" study. Of course, the results indicate that the actual cost depends on a range of factors including what part of the country one lives, whether an at-home aide is hired, or whether one moves into a skilled nursing facility. As any New York elder law attorney can attest, our area is always at the very top of the list when it comes to long-term care costs. It is for that reason that it is particularly incumbent upon area resident to meet with an elder law attorney to plan ahead before the costs actually need to be paid. It is simply impossible for most families to bear the financial burden of this care on their own.

This latest research effort from Northwestern Mutual involved surveys from 6,000 different sources, including a mix of assisted living facilities, home health care organizations, and nursing homes. The researchers found that the hourly rate for home healthcare workers was anywhere from $33 per hour to $15 per hour. New York assistance was near the highest of the group.

Assisted living facilities had rates anywhere from $1,500 a month to just shy of $7,000 per month. As with home health care workers, our area has particularly expensive assisted living facility prices. In addition, it is often difficult to even get into one of these facilities, as many of the best have long waiting lists of folks hoping to get a spot when there is an opening.

Nursing home care is particularly expensive, both in New York and throughout the country. The average cost throughout the country is around $90,000 a year. However, rates in our area can rise to more than double that amount, usually over $10,000 a month. It is important to note that these costs do not even include related expenses like use of medical equipment, transportation, and medicine.

The research project also determined that right now there is a 66% chance that a senior over the age of 65 will eventually need long-term care. Similar surveys have identified that rate as even higher. Overall, that means that for most residents the question is not a matter of if they will need this care but when. With odds like those it is simply common sense to take the time to plan for the care ahead of time. Local residents who conduct even basic New York elder care planning can save hundreds of thousands of dollars in assets that otherwise would vanish had the preparations not be taken.

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The focus of most New York elder care planning discussions naturally revolves around the needs of seniors. Are they receiving proper nutrition? Do their caregivers timely attend to their dressing, bathing, and washroom needs? Do they remain connected to the community with opportunities to use their unique skills and abilities? Our New York elder law attorneys know that for far too many seniors, even these basic needs remain unmet. The problem of elder neglect and abuse is troubling, and it will likely become more of a concern in the coming years as the population ages and the total number of seniors in need of extra help skyrockets.

However, a holistic approach to senior care requires not just consideration of the senior's needs but also understanding of the effects on senior caregivers. A CNN Living article this week examined the way that helping an elder resident impacts adult family members. The story of one woman was shared who took her 72-year old father out of a nursing home out of concerns for his well-being. Instead she moved him into her on own two bedroom apartment. The woman admits that she put her life on hold, because the obligations of working full-time while helping her father was overwhelming. She was often required to miss work to take him to a wide range of appointments with medical professionals. In addition, she used her lunch breaks to ensure he took his medications and made it to his dialysis appointments. She confesses, "It was like 'oh my, what did I get myself into?' Sometimes I would just go into the bathroom and cry."

Her situation is not unique as a new "Stress in America" survey from the American Psychological Association found that at least 55% of senior caregivers feel overwhelmed by the task. Not only did the caregivers report higher levels of personal stress, but they were also found to be in poorer health themselves. Caregivers were more likely to engage in unhealthy behaviors in an attempt to alleviate the stress.

As any elder law attorney or others involved is long-term care planning can attest, the quality of care received by a senior is directly dependent on the work and well being of their caregivers. If caregivers are stressed or unhealthy, there will likely be repercussions for the elder. That is why psychological experts suggest that families be realistic when conducting long-term care planning or deciding what to do when a senior is in need. The psychologist leading the latest stress report explained, "It's impossible to be all things to everyone, so what we have to do is have honest straight talk with ourselves about how much we can handle and when we seek help from others."

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Laws change. Elder law and estate planning strategies change. But the basic principles surrounding inheritance planning, disability planning, and preparing for one's golden years have been around for centuries. In a soon to be released book from Harvard University Press entitled Someday All of This Will be Yours: A History of Inheritance and Old Age, author Dick Hartog takes a look at some of those timeless principles that have involved elder law and estate planning over the years.

A recent book review summarized the text by noting that Hartog (a legal historian) examines how "ordinary men and woman arranged for their own care as they aged, and then how their alleged caretakers attempted to use the law to make good on these arrangements." Of course our New York elder law attorneys are immediately drawn to these sorts of topics as helping local families make these arrangements is a large part of our practice today. The new Hartog book looks at dozens of elder law cases over the years and "closely, carefully, and painstakingly examines these cases for what they show about changing patterns in care for the elderly, parent-child relations, [and] the tensions between family and commodification." The book discusses how these issues have changed or not changed over the years.

While the principles have likely remained unchanged the strategies to carry out wishes has undoubtedly shifted in recent decades. For example, Hartog discusses how in many circumstances elderly parents convinced children to provide the caretaking they needed with promises (sometimes legally enforceable, sometimes not) that family assets would be passed to them so long as the care was satisfactory. He explains that the core inducement of providing such care was the understanding that a family farm, home, bank account, or other asset would be passed to the child in exchange for the child providing the help that the elder needed with tasks like cooking, cleaning, nursing, or even just companionship. Hartog also discusses how elder law attorneys have gotten involved over the years to help seniors, particularly when those previous promises are not fulfilled.

As the book review author noted, elder law is an area that is finally coming into its own. While our New York elder law attorneys have been working on these issues for years, we appreciate that that it is still difficult for many families to find professionals with specific experience in the wide range of issues related to planning for seniors. Fortunately, most law schools now have at least one elder law course. Hopefully awareness of these issues will continue to grow so that more families take the time to plan in ways that take full advantage of the current available legal tools.

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Making the decision to place a loved one in a nursing home is no routine matter. Emotions run deep during this time, when families struggle to balance the senior's need for close care and safety with their concerns about the quality of life available in these assisted-living facilities. Our New York elder law estate planning attorneys have helped many families with this process. We appreciate that there are usually two big questions that come up: (1) What is the best facility for our loved one? and (2) How are we going to pay for it?

In answering the latter question, New York elder law attorneys will explain that the costs can either be paid out of pocket, via use of private long-term care insurance, or through the New York Medicaid system. The former question is a bit more challenging, because so much subjectivity is involved. The answer for each family is different. The exact type of care needed, proximity to loved ones, and similar details need to be considered when choosing which nursing home is best. Of course, as a general matter, every family will want to ensure that the nursing home they chose is one free of chronic neglect, mistreatment, and abuse. Many elder care advocates have explained that when it comes to safety measures, study after study has found that nonprofit nursing homes outperform for-profit facilities. One long-term care doctor explained, "Most studies show that nonprofits do a better job of caring for patients, but we're not sure why that happens." This is an important consideration for families deciding where to send their loved one.

A post this week in the New Old Age blog from the New York Times recently discussed another interesting comparison between for-profit and nonprofit homes: the employees are happiest at nonprofit nursing homes. This may be part of the reason why care at these facilities is superior. At the end of the day, the quality of life for those in these facilities is dependent on the work performed by the hands-on caregivers. Therefore, how those caregivers perceive their job is likely to play a key role in their day-to-day actions. The nonprofit employees were happier overall for a variety of reasons: their ability to help set policy, more supportive managers, and availability of adequate resources.

One corollary is that staff turnover at nonprofit homes is much lower than at for-profit facilities. It is not hard to see how consistency in the workforce helps breed experience and better overall care. Long serving nurses and nurse's assistants can gain familiarity with each resident and are better able to understand their quirks, notice problems, and respond quickly to their needs.

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Many writers have taken to calling the upcoming wave of baby boomer retirements as the "silver tsunami." Like real tsunamis, the demographic shift is expected to have many ripple effects in communities across the country. Each New York elder law attorney at our firm has seen first-hand the challenges faced by many in our area when trying to figure out where they will receive long-term senior care and how they will pay for it. These issues are common to all local families who have loved ones about to leave the work force to enjoy time in their golden years.

However, some senior community members have even more unique concerns.

The Associated Press published an interesting article this week discussing the struggles of senior GLBT community members. Public opinion data consistently shows that the younger generation is much more open and supportive of their gay, lesbian, bisexual, and transgendered community members. Older Americans are less approving. That is leading many gay seniors to wonder how they might be treated if they end up in a traditional nursing home or long-term care facility. One expert summarized that many of these "seniors fear discrimination, disrespect or worse by health care workers and residents of elder housing facilities, ultimately leading many back into the closet after years of being open." In addition, GLBT seniors are much less likely to have biological family members to help them through this time of their life. Estrangement and childlessness are more common for gay seniors, making them more dependent on outside services.

These concerns affect a sizeable minority of local residents. Of the 77 million baby boomers expected to retire this year alone, more than 1.5 million are gay, according to the New York group Services and Advocacy for GLBT Elders (SAGE). These concerns have led many to call for an increase in gay-friendly senior housing options. Our New York elder law estate planning attorneys recognize the unique needs of this community, having long helped GLBT residents with their inheritance planning, tax considerations, and New York elder care planning.

Fortunately, some developers are taking the opportunity to fill the need for senior care options for the community. A new 52-unit GLBT-friendly affordable housing unit is breaking ground in Philadelphia this year. The $17 million building is set to open in 2013. A similar project is also in the works for New York City, though the project still has many hoops to jump through. The only finished facility of this sort is in Los Angeles. That 104 unit facility is already filled, with a 200 person waiting list. Private retirement facilities for gay seniors already exist, but these options are often financially out-of-reach for many residents. The lower cost options will hopefully fill the void and provide vital services for this community.

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New York City is renowned for its lack of sufficient senior living options. New York elder law attorneys know that competition is often intense for available spots in some of the better long-term care facilities. That competition will only grow more intense in the coming years as the number of available rooms drop and demand from the senior community increases. If more facilities aren't built, it will likely become even more difficult to access the highest quality elder living options, particular those that prioritize senior quality of life. As the chief executive of the International Council on Active Aging noted, "What used to work is no longer an option. We're moving from being a care society to one where we take self-responsibility."

Many more are growing aware of the looming housing crisis and are working to expand New York elder care options. For example, on Tuesday the Wall Street Journal reported on a new, ground-breaking nursing home that is set to be constructed on the city's Upper West Side. Those involved in the project explained that a 24-story Jewish Home Lifecare nursing home will be built at 97th Street between Amsterdam and Columbus. It will accommodate 288 total residents.

Those involved in the project explain that the new facility is intended to offer original designs and unique modes of staffing. It seeks to do away with the old-fashioned (and often despised) institutional approach with shared rooms and long corridors. Instead, the facility is being built to feel more like regular homes with private rooms clustered in small, 12-room pods. The staffing will also be different than the norm. Under the current plan the same two nursing assistance will be assigned to each apartment cluster. Those caregivers will go beyond tasks done in regular homes and instead also help with cooking, light housekeeping, and the facilitation of recreational activities.

This pioneering project has been in the works for years. Those involved have long wanted to build a facility with this new model, however it has been a challenge to marshal the appropriate resources to actually move ahead with the space-intensive design in the high-rise environment. However, things now appear to be in green-light mode. The $250 million project is set to break ground in February of 2013 with move-ins slated for the Spring of 2017. One New York elder law attorney explained that this project is clearly the area's most ambitious new senior housing development. He noted that is comes at a precipitous time considering the need for such spaces to accommodate aging Baby Boomers.

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Local seniors obtain peace of mind knowing that they will be able to receive late-in-life care in an ideal setting and that the care will be of top quality. These simple goals should not be out of reach for any elder community member. However each New York elder law attorney at our firm knows that many seniors will be forced to deal with less than adequate care, often in institutional settings where they would rather not live.

Part of the problem is that many local residents will not have visited with a New York elder law professional ahead of time to plan for this time in life. Staying in one's home while aging usually requires advance planning. However, it is not enough to merely have the aid of a home care worker--one must ensure that the worker is actually providing an appropriate level of care. A recent article from Aging Parents explained that there has been a shortage of quality home care workers. One of the problems, argues the author, is the fact that for a period these workers were exempt from minimum wage laws. When Congress passed minimum rights legislation, all home care workers were lumped into the category of exempt employees who acted as "companions." This was the case even for workers who engaged in a wide range of physical labor helping seniors bathe, dress, use the facilities, walk, get exercise, and eat properly. Of course, it seems intuitively unfair for these workers to be forced to live in dire poverty at incredibly low wages and no overtime pay.

Fortunately, the legal error was recently corrected. The author suggests that part of the reason the law took so long to change was that many of the individuals who fill these roles have few advocates, often including women and those who are not native English speakers. Also, as a result of the prolonged period of abysmal pay, advocates are worried that there is a shortage of well-trained, capable home health care workers. The need for these workers is expected to skyrocket in the coming decades.

The shortage of quality caregivers makes it important for local residents to conduct proper research when deciding on an appropriate home care provider for their loved one. A New York elder care plan that allows for home care is of little value if that home care worker is inadequate. Therefore, most advocates recommend going through a qualified agency to find these assistants. Most agencies are required to perform multi-state background checks, screen for drug use, and require references. The risk of abuse or theft is always much higher when home care workers are unsupervised and unaccountable.

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Each New York elder law attorney at our firm understands that maximizing the quality of life for local seniors requires both proper individual planning and common sense elder law policy proposals at the local, state, and federal levels. On the planning side, all local residents should visit with a New York elder care lawyer to prepare for disability, save taxes from Medicaid costs, and deal with similar issues. When it comes to policy, it is helpful to stay up to date with changes that are being proposed which may affect the lives of seniors. One of the key governmental bodies related to these issues is the U.S. Special Committee on Aging. This Senate committee has been at the center of all important federal elder law issues over the past half century.

Last week the National Academy of Elder Law Attorneys (NAELA) issued a special proclamation honoring the 50th Anniversary of the U.S. Special Committee on Aging. NAELA, a nationwide group of elder law attorneys, also co-sponsored an event in Washington D.C. honoring the committee's achievements.

The Special Committee was first created in 1961 as a central national clearinghouse to discuss and deliberate on a wide range of issues that affect senior citizens. Over the years the committee has been involved in any number of senior issues, from health care problems and elder financial exploitation to retirement security and nursing home abuse. In recent years the Special Committee on Aging has led the way in passage of the Elder Justice Act, Older Americans Act, and a wide range of issues seeking to improve the care at long-term skilled nursing facilities. Last year the committee brought national attention to senior housing issues during its hearing entitled "Continuing Care, Retirement Communities: Secure Retirement or Risky Investment?" In recent years the Committee served as the center of other important debates such as during the hearings "Exploitation of Seniors: America's Ailing Guardianship System" and "Sound Policy, Smart Solutions: Saving Money in Medicaid."

The overall mission of all those public officials on the committee and the advocates who testify before it is improving the quality of life for older Americans. The committee's mission has taken on even greater importance in recent years as a larger and larger percentage of Americans become seniors with the aging of the Baby Boomer generation. Many advocates have warned that housing options for seniors and access to appropriate healthcare will gain even more importance nationwide in the coming years. The U.S. Special Committee on Aging will undoubtedly play a central role in understanding those issues and figuring out possible policy solutions.

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This month the AARP's Public Policy Institute, in conjunction with the National Conference of State Legislatures, released a new report that is of direct applicability to all those concerned about their New York long-term care plans. Entitled, "Aging in Place: A State Survey of Livability Policies and Practices," the project is focused entirely on analyzing what states are doing (or not doing) to help seniors stay in their own homes as they age. As the report authors note, the vast majority of seniors prefer to age in place, but their ability to do so is in many ways dependent on how communities are designed and senior care programs implemented. Toward that end, the report took a look at land use policies, transportation services, and housing options across to country which are helping seniors meet their goal of avoiding the need to move.

When it comes to land use, the report found it crucial to integrate necessary services with transportation planning to reduce automobile travel. If older adults can more easily walk or otherwise reach necessary support services, they will be able to live in place longer. Also found to be helpful were requirements for implementing transit-oriented development within a half mile of transit stops and joint use of community facilities for senior centers and health clinics. Similarly, increased public transportation options are important to the efforts of many seniors to stay in place. "Complete street" policies are in place in some states requiring designs which allow travelers of all ages and abilities to navigate the street. The policy institute also suggested better coordination between human service transportation agencies. The coordination allows these agencies to do more with fewer resources.

When it comes to housing, many elder care plans are created specifically to help seniors have access to preferable living situations--usually outside of the nursing home. However, the AARP report found that there is a shortfall in affordable and accessible housing for seniors, making it difficult to avoid the institutional setting. To help, the authors suggested states make use of the federal Low-Income Housing Tax Credit programs to obtain more funds to increase the affordable housing supply. Similarly, developers should be encouraged to increase accessibility by altering building standards.

Our New York elder law attorneys know that our state has a long-way to go to help ensure all seniors can age in place. A comprehensive study last month (also from the AARP) actually ranked New York dead last in total percentage of at home care residents. In other words, more residents in our state as compared to elsewhere are forced to move out of their long-time homes and into alternative living arrangements to receive the day-to-day assistance they need.

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The Nieman Watchdog--Harvard's journalism faculty blog--recently published a commentary speaking to the looming "retirement crisis" and the problems with the federal government's current approach to dealing with it. The author notes that retirement planning is not what it used to be as many workers today are "facing a grim future in which the kind of retirement plans their parents were able to take for granted is out of reach." Our New York elder law attorneys have discussed these changing dynamics and the demand they place on thinking about long-term care plans in new ways.

The commentary notes that it is folly to presume that one will be taken care of in the future, because the growth of "defined contribution plans" (as opposed to "defined benefits plans") means that retirement savings often hinge on the performance of the markets. It is argued that this shift has made income from private pensions smaller and less reliable than in the past. That issue, coupled with rising health care costs, places a real strain on many retirement plans.

Considering those concerns, it is perhaps surprising that federal policymakers have spent most of their time discussing cuts to Social Security, Medicare, and Medicaid. The problem also exists at the state level, as New York Medicaid planners have been forced to watch as state policymakers consider a wide range of proposals to revamp the healthcare system that so many local seniors rely on for long-term care support.

Some suggest that the aging population combined with possible cuts to stalwart federal programs like Medicaid will ultimately send many more seniors into poverty. This is particularly true of those who have not conducted any elder care planning ahead of time. According to the latest figures from the U.S. Census Bureau, last month roughly 16% of all seniors were living in poverty. It is likely that the rate will rise significantly as seniors are forced to pay more for their health care to make up for possible program cuts. Right now seniors spend about 16% of their income in out-of-pocket health care costs. However, even under the current law, that rate is expected to increase to roughly 30% in the next few decades.

These frightening statistics are one of the reasons that researchers at the Center for Retirement Research at Boston College suggest that more than 50% of all baby boomers will not have economic security in retirement. The research identified "economic security" as income at 70% to 80% of their working wage.

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