New York Elder Law Attorney Blog

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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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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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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Last Thursday a group of elder care advocates, seniors, and local politicians held an event to raise awareness of the possible closure of area senior centers. According to a report in Staten Island Live, the gathering was specifically called to ask Governor Cuomo to refrain from making changes to state Title XX funding. The proposed changes would essentially cut roughly $25 million from the budgets of senior centers citywide. Held on the steps of City Hall, state Senator Diane Savino led the event where more than 15,000 letters were unveiled written by seniors explaining how the cuts would affect their lives. Our New York elder law attorneys are aware of the ways that many local elders rely on various support services offered at these facilities.

The Title XX funding accounts for about a third of the total financial support provided to these centers. However, the funding is discretionary and some are proposing that it be moved over to support child welfare services. If the changes are made over a hundred senior centers will be forced to close. Lillian Barrios-Paoli, the Department for the Aging Commissioner repeatedly emphasized that the lives of thousands of seniors would be made qualitatively worse if these proposals were to advance. She explained that "this is an issue that shouldn't even be debated."

Others are questioning why such a proposal would even be brought forward in light of the changing demographics. As we have often reported, the elderly population is the quickest growing age group nationwide. The trends are no different in our area. Baby Boomers are now beginning to retire--a trend that will last for decades. The growing senior population means that New York elder care planning needs to be conducted now in anticipation of the needs of this population. Eliminating services to this group would seem to be a step in the wrong direction. Senator Savino commented on the pressing concerns already facing seniors by noting that "we have enough things to worry about. Take this off the table."

The director of public policy for the Council of Senior Centers and Services of New York City noted that these facilities have been relying on the Title XX funding for the past thirty five years. She said that eliminating the money would have serious effects on the already vulnerable elderly population. For example, right off the bat there would be two million fewer meals provided to the neediest seniors every year.

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Last week the Director of the New York State Office for the Aging held the first-ever New York Caregiving and Respite Coalition Conference. Over 120 participants attended the event, which was meant to honor all those family members across the state who provide vital services to their friends and family members in need of New York elder care or disability assistance. Literally hundreds of millions of caregiving hours are provided every year in informal settings by community members who provide anything from around the clock help to periodic aid to seniors and disabled residents. As an AARP report last month revealed, the value of the senior care services provided free of charge dwarfs the total care provided by public bodies, usually via Medicaid. Specifically, the report found that New York coffers alone are saved $3.2 billion because of the work of these friends and family members.

Recognizing the sacrifices made by so many family members was at the heart of Governor Andrew Cuomo's issuance of a proclamation declaring November as Caregiver Recognition Month. In making the statement at last week's conference, the Governor explained of family caregivers that "their commitment, generosity and dedication make a profound difference in the lives of others and reflects the best of the Empire State."

Our New York elder law attorneys know the impact that family caregivers have on the lives on their loved ones--and on the state's entire elder care system. As the Governor explained in his address, the state estimates that more than 50% of senior New Yorkers would likely be placed in institutional settings without the aid of unpaid caregivers. These nursing homes and other special facilities are rarely the preferred living option of seniors who are almost always happier when they age in place, close to their loved ones.

Conference participants also used the occasion to discuss ways to strengthen the New York State Caregiving and Respite Coalition (NYSCRC). In particular, it is hoped that a stronger and more expansive caregiver support services network can be developed statewide. Ideally this system would increase access to respite services for all those friends and family members who are providing New York senior care informally. Participants also hope to raise awareness of available services for caregivers. Many of those currently helping disabled residents do not know what resources are freely provided to help ease the burden on these volunteers. The New York State Office for the Aging has created and made available a variety of programs, services, and resources, and local residents should visit the office's Resource Guide to gain access to these helpful materials.

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The AARP Public Policy Institute recently released a new report discussing the contributions that family members nationwide make to caring for their elderly family members. Recent news has focused on how local, state, and federal governments will handle the burdens of caring for an aging population. Yet, as this new report points out, the costs bore by family caregivers actually dwarfs that spent by these public bodies. It is a reminder that long-term care planning remains more than just a necessity for seniors but also for their entire family.

The size of the numbers is undeniable. Roughly 42 million family members are acting as caregivers for their senior loved ones at any point in time, with nearly 62 million providing at least some support throughout the year. In economic terms, these caregivers provide over $450 billion in annual, unpaid care. That total is up 20% from two years before ($375 billion). These totals include the contributions of millions of area residents who provide support for aging family members whose New York elder care planning went awry or whose plan was nonexistent. The financial estimates are actually conservative. They do not account for care given by those under the age of 18. They also do not include caregivers who provide assistance outside of basic daily living tasks, like help with bathing, dressing, managing medications, and aid with finances.

It is helpful to put these family-provided long-term elder care costs into context. The $450 billion annual sum is more than the total Medicaid spending, for both basic health and long-term support services. When looking only at Medicaid support for senior care, the costs bore by families is four times larger. Researchers believe that the $75 billion increase in the previous two years was primarily caused by an increase in the total number of caregivers and hours of care provided. In other words, the allotted value of the work ($11.16 per hour) remained constant over that period of time.

The report notes various caregiving trends. Nearly sixty five percent of caregivers are women and more than eight in ten are caring for a relative over 50 years old. The "average" caregiver is a 49 year old woman that works outside the home and spends 20 hours a week providing unpaid care to her mother. Of course, countless other scenarios exist, but in many ways, women dominate the process--both as caregivers and ones in need of care. This is likely the case because women live longer than men on average and cultural pressures still tend to encourage women to act as caregivers more than men.

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The aging of the population both in our state and throughout the country is leading many community members to re-think the best way to provide long-term care for seniors when they reach their golden years. In the past, options for seniors were few and far between. In most cases a senior lived on their own for as long as they could. When extra care was needed it was provided by a close relative if possible. If no relative was able to provide the care, or the senior's needs were more than a relative could handle, then the individual ended up in a nursing home. Most seniors in our area were unable to pay for that nursing home care on their own, and so it was paid for by New York Medicaid programs. However, most of the seniors' assets built up over a lifetime were lost to pay for the care or to qualify for Medicaid participation.

Recently, there has been an explosion in new options available to area seniors and their families, particularly for those families that take the time to visit with a New York elder law attorney to plan ahead for this stage in life. For example, many assisted-living facilities have been built which allow seniors to receive day-to-day aid from professionals while keeping much more independence than that found in traditional nursing homes. Other services are popping up which allow seniors to receive extra care without leaving their home at all.

For example, this week Bright Days Home Care, a new "senior companion" service announced that it was opening its doors to provide assistance for local residents. The New York elder care service provides companions to visit the homes of seniors on a particular schedule to provide any manner of aid necessary. This new service provides non-medical care, which may include anything from buying groceries and making dinner to cleaning the house and chatting with the senior about their day. In addition, the company's founder explains that the at-home service also helps local families find other resources. She notes that they "are committed to ensuring that people are aware of the plethora of options that are available."

Many local seniors may be able to live at home longer by utilizing this or similar services. At-home companion care can also compliment medically-based at-home assistance to provide even more comprehensive support for the resident. That medical assistance could include home nurse visits or installation of technologically advanced tools that allow medical caregivers to monitor a senior from afar. Whatever combination is ultimately best for you or your loved one, the first step is ensuring that you will have the resources necessary to pay for this care when it is needed.

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Syracuse News reported this week on public concern over changes that are about to take effect within the New York Medicaid system. Per the planned alterations, many local residents with developmental disabilities will lose their caseworkers as that task is soon to be outsourced to non-profit agencies in the state. Currently, many of these residents receive assistance from a group of public employees known as Medicaid service coordinators. However, these residents have been instructed that by the end of this week they must select a non-profit to take over this function.

Many community members are concerned about the effect the changes will have on their vulnerable family members with disabilities who have grown familiar with their personal caseworkers over many years. The service coordinators function as advocates for program participants, developing relationships with the clients and helping their family find the services that they need. Many coordinators have helped families find appropriate educational opportunities, arrange for respite care, and have linked participants with employment programs. Our New York Medicaid attorneys are aware of the complications that are intrinsic in working through the Medicaid system, as we also devote our time helping local residents work within the system to protect their assets while receiving the resources that they need to get by each day.

Cost-cutting is the state's motivation for changing the way the services are provided. The state spokesman for the Office for People with Developmental Disabilities reported that non-profit agencies already handle roughly eighty percent of Medicaid service coordination in the state. Nonprofit agencies explain that they are prepared to handle their expanded role. However, they also report that it may be difficult to complete the transition in a month--which is the goal of the administration. Even if the changes go through, there is a chance that families may be able to remain with the same service coordinator if that coordinator is hired by a nonprofit after leaving the state payroll. The program shift will allow the state to cut 300 service coordinators who had previously served about 10,000 local residents. Current service coordinators may try to approve an amended contract and submit it to the state in an effort to halt the layoffs. However, there is no guarantee that the privatization effort will be halted.

These latest New York Medicaid changes are part of a wide range of alterations that will likely take place over the coming years in an effort to help the state absorb the program's growing costs. Other proposed changes may affect the way that seniors and other program participants use the service to receive the extra care they need. Our New York Medicaid lawyers urge all local residents to visit with professionals to plan ahead for all long-terms health and financial concerns.

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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.

See Our Related Blog Posts:

Having "The Talk" With Elderly Parents

Tips for Children Caring for Aging Parents