Articles Posted in New York Elder Law

The combined pressures of growing need, rising costs, and altered ideas of the best way to live one’s golden years is leading to a revolution in the look and feel of elder care. To be sure, changes in the way seniors in need receive support are still occurring far too slow for some advocates. But it is undeniable that many seniors now are cared for differently than their parents and the trend will only continue in the coming years and decades.

One common suggestion is that communal living spaces (like nursing homes) are closing and being replaced by a growth in at-home caregivers. While that change is occurring, it oversimplifies the new landscape of seniors care. There are different version of at-home support and even communal living.

Senior Villages

A somewhat bizarre story out of Europe is leading a few elder care experts in the United States to question whether “shipping away” seniors may be part of the future of long-term care for some families.

As reported by the BBC, one adult daughter in Switzerland ignited an ethical debate recently by deciding to send her mother to a long-term care home in Thailand for support. The daughter explained that her decision was based on both her mother’s specific condition and financial realities. The 91-year old mother apparently suffers from severe dementia, and is unable to remember much of anything about the present. In addition, the cost of care in Switzerland was incredibly high–similar to that in New York–while Thai care was far more affordable. The daughter felt that her mother could receive better services in Thailand where she now lives with a group of other Swiss and German seniors.

A Wave of the Future?

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.

The look and feel of elder care in the United States is changing. In the distant past, most care was provided by friends and family members at their own homes. Later, larger facilities (nursing homes) were built to provide more consistent care to all seniors, especially those without options for family support. Now, however, care is shifting back to the home. This change is pushed by many factors, including the rising costs of nursing home care and the preferences of individual seniors to avoid institutionalized living.

More Options Than Ever

One interesting driver of the change are advances in technology which offer increasing support options available to seniors living at home. A Huffington Post story explored the different ways that these tools are helping improve elder care. While some of the most advanced systems are still in the works, many simple tech tools are already being pushed out to greatly improve senior services.

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:

Debate and discussion around the ideal setting to care for older individuals has raged for decades. The trends are somewhat cyclical.

In the distant past, virtually all aging took place at homes. “Traditional,” nuclear families were more common, and so seniors who could no longer live on their own almost always moved in with family members. Long-term care facilities were virtually non-existent.

However, seniors who did not have available family caregivers or who needed more support than caregivers could provide were left in dire straits. The growth of various senior housing locations filled the gap. These separate spaces catered exclusively to senior needs, ideally providing better, more efficient care without overburdened family support networks.

The face of long-term care in New York continues to change. In the past, when seniors were in need of close, around-the-clock care their main option was to move into a skilled nursing home in their community, usually owned by the county itself. These public facilities long acted as the main source of institutional support for ailing seniors.

But things are changing. For one thing, many more seniors are being proactive about their long-term care, creating elder law estate plans that ensure they have more options, including at-home care that allows them to age in place.

On top of that, more and more county owned and operated nursing homes are being sold off to private investors. Finances are at the center of the switch, as tight local budgets are making it very difficult for local policymakers to justify losing significant funds year over year on this care. Recent reports have underscored the situation, noting that virtually all of the county-run nursing homes in New York are operating in the red.

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.

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