Articles Posted in Long Term Care Planning

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

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

The Recommendations

A new study from researchers out of Rochester, New York took a look at quality of care trends from 11,500 nursing home and compared them with the racial make-up of residents in those homes. The summary finding from the project which is making headlines is that long-term care facilities with a higher percentage of black residents provide lower quality care.

First published this summer is a publication known as Health Services Research, the investigation involved analysis of data related to quality of care as well as financial performance over a five year period (1999-2004). Most information was culled from reports provided by the Medicare and Medicaid programs. Those facilities with zero residents on those programs were not included in the research.

The Connection Between Revenue and Nursing Home Care

Yesterday we touched on changes in exemption rules from the U.S. Labor Department which will affect the federal employment rights of home care workers. As discussed, observers on both sides have made predictions on how the changes will affect home care nationwide. Some argue that better treated employees will provide better care to seniors. Others suggest that the home care industry cannot absorb the increased costs and the total number of full-time caregivers will be cut as a result.

But a more important question for New York residents and their families is more preliminary: Is home care right for us?

Making Careful Choices

Nursing homes have a reputation for being ‘behind the times.” New York in particular has a somewhat abysmal track record of providing high-quality care. One on hand, the problems are rooted in finances and personnel. Often operating on tight budgets, some facilities cut corners on staffing, leading many residents to languish without the hands-on care that they need to get by each day.

On top of that, however, there are innovation challenges. Rarely are nursing home lauded for being at the cutting edge of improvements which take advantage of new trends and caregiving approaches. You often read about hospitals or medical clinics that are using the newest and the latest tools to provide care to patients–nursing homes don’t often receive the same plaudits.

Behind the Records Curve

Advocating for better long-term care is not just a concern of NY elder law attorneys. Policymakers at all levels and of all political persuasions are also keenly aware of the impact that the growing need for long-term care will have on communities nationwide.

There are few challenges more acute than figuring out how to ensure adequate senior care for all community members. As most know, we are on the cusp of a “gray wave” with demographics changes requiring an increased commitment to skilled care and assistance for seniors. The need extends to all facets of elder care, from ensuring there are enough physical spaces for those in need to coming up with ways to pay for the care.

Federal LTC Commission

Life insurance is a common tool used by New Yorkers to protect loved ones in the event of an uncertain future. At other times it is a useful way to transfer assets to a new generation, often with significant tax benefits. While there are different types of life insurances (term, universal, whole), the basic idea is the same. An individual enters into a contract with the insurance company to send monthly payments (premiums) in exchange for a lump payment to the insured’s beneficiaries in the event of death.

Naturally, the amount that you have to pay in a monthly premium to receive a certain size of lump sum depends on different factors. The life insurance underwriting process is complex, but it usually seeks to evaluate one’s general risk of dying in a certain period. Age is huge factor. It will cost far less for a 20 year to purchase the same value insurance as a 75 year old.

Factors That Can Be Considered

The nursing home options for New York seniors is changing rapidly. In the past, many facilities were owned publicly, usually by local counties. Elder care advocates often praise these models, because there are concerns about how the profit-motive of private homes affects overall care. Studies have shown that non-profit homes have better overall caregiving records with fewer deficiency citations.

However, finding available beds in a non-profit nursing home is becoming increasingly difficult in New York.

Shift to Private Homes

Our NY estate planning lawyers frequently advise local residents that in virtually all cases the single best way to prepare for possible senior care needs is by purchasing long-term care insurance (LTCI). Unfortunately, the biggest barrier for most families in securing LTCI is cost. Depending on one’s age when purchasing the product, the premiums can be prohibitive. Gender also plays a role, as women may have higher rates because of their longer life expectancy. We reported last month on one large LTCI insurer, Genworth, making the decision to institute “differential pricing” to charge women more. Reports suggest there could anywhere from a 25% to 40% gender price gap.

Of course the trajectory of these insurance costs mirror the actual costs for nursing home stays or at-home caregivers. As the price of that care rises, so does the cost of LTCI insurance.

Act Now and Act Smart

It is no secret that most New Yorkers would prefer to “age in place” instead of moving into a nursing home. For one thing, having access to the comforts of one’s own home and the freedom to live as independently as possible is a natural goal. On top of that, however, are the myriad of horror stories that continue to pop up regarding mistreatment, neglect, and outright abuse that is sometime perpetrated at skilled nursing facilities. If you read enough of those harrowing accounts, it is easy to get the impression that these homes are no place to thrive in your golden years.

A new story coming out of Queens offers little relief. As reported this weekend in the NY Daily News, a former director of nursing at a Queens facility is now facing criminal charges for her conduct following a resident’s wandering from the facility.

Authorities explain how two weeks ago a 74-year old resident of the facility went missing. He was apparently not properly supervised and wandered out of the home without notice of the caregivers. The man has dementia, and obviously is at risk of serious harm while alone in the community. The senior has still not been found.

The stigma associated with life in nursing homes remain strong. Many seniors do everything in their power to avoid moving into a skilled nursing facility over fears of the quality of life that residents experience. These are common worries, and a key reason that New York resident conduct early estate planning and elder care planning to ensure they are doing everything they can so they have quality living options if necessary down the road.

Unfortunately, progress in addressing quality of life issues at these facilities is often slow-going. For example, one of the most well-known issues affecting nursing homes throughout the country, including New York, is the overuse of antipsychotic drugs to “control” residents. These “chemical restraints” make it easier for employees to watch a larger number residents. But the drug use drastically lower the quality of life of many residents, often placing them in a stupor without the ability to meaningfully interact with the world.

The problem of chemical restraints have been known for years, and recently federal agencies pushed to tackle the issue. But, so far, the progress has been limited. As a New York World story noted, the overall decrease in antipsychotic use is modest and some facilities throughout New York continue to increase use of the dangerous drugs.

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