New York Elder Law Attorney Blog

Family Input Can Lead to Earlier Dementia Detection

Wed, 08 Feb 2012 08:19:40 -0500

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.

See Our Related Blog Posts:

Primary Progressive Aphasia Remains Little-Known Form of Dementia

The Rising Incidence of Alzheimer's Disease

Men Find it Harder to Get a Bed in New York Nursing Homes

Mon, 06 Feb 2012 06:44:27 -0500

Many residents remain completely unfamiliar with most aspects of New York elder care until the need for skilled long-term treatment is thrust upon them by a loved one's sudden health decline. For one thing, the high costs of the service catch most community members completely off-guard. Coming up with over $10,000 a month (or more) for this care is simply impossible for most areas families that have not planned ahead of time. On top of that, our New York elder law attorneys know that many are also surprised by the challenge of simply finding a suitable facility in the first place, regardless of the costs.

One peculiar aspect of the process, for example, is that men have a harder time finding a bed in nursing homes than women do. The situation was discussed last week in a post at the New York Times' "The New Old Age" blog.

It was explained that the problem has to do with nursing home demographics. A 2010 CMS Report noted what most intuitively suspect: two-thirds of all nursing home residents are female. In some specific areas, the rate of female use of these facilities is much higher. As our New York Medicaid lawyers often explain to clients, Medicaid--which pays for most nursing home care--only covers "semiprivate" rooms. These rooms usually house at least two residents with privacy provided, as in a hospital, by a curtain. Only residents of the same gender can live in each room.

That is where the demographic problem comes in.

Men who are seeking to enter these facilities cannot be put into a room where a woman already resides--even if there are open beds. Therefore, the man is forced to wait until there is a bed available in a room with another man. Considering the skewed demographics, there are a lot fewer male rooms, and the wait can last longer than many expect.

The financial demands on these skilled long term care facilities also play a role. For example, when residents leave a facility, there are often ways to make bed changes so that a room opens up to serve as a male room. However, many facilities are reluctant to do that, because the chance of a bed going unused in a male room is higher than in a female room. If the facility accepts a man and then three woman immediately call and want to move-in, they may have to turn those three down because they used an open room for the man instead of making it another female room. Most long-term care facilities are understandably loathe to not lose money on unused space, and so decisions about room assignments are often affected by the financial motives.

See Our Related Blog Posts:

Survey Finds Many American Fail to Conduct Long-Term Care Planning

More Americans Financially Supporting Aging Parents

Federal Judge Rules Long-Term Care Ban Unconstitutional As It Relates to Same Sex Couples

Thu, 02 Feb 2012 10:01:22 -0500

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.

See Our Related Blog Posts:

Married Same-Sex Couples Need to Consider Effect of Defense of Marriage Act

Marriage Equality May Change New York Estate Planning Needs for Same Sex Couples

Elder Law Associations Announce Support for Older American Act

Tue, 31 Jan 2012 08:53:34 -0500

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.

See Our Related Blog Posts:

Nonprofit Innovators Try to Shift Senior Care Away From the Nursing Home

New York Long-Term Care Near the Most Expensive in the Country

The Many Challenges of "The Long Goodbye"

Fri, 27 Jan 2012 09:05:07 -0500

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.

See Our Related Blog Posts:

New York Ranks Poorly on AARP Long-Term Care Scorecard

Do Not Let Long-Term Care Destroy Your Retirement Planning

New York Medicaid Program Drug Prescriptions Under U.S. Senate Microscope

Wed, 25 Jan 2012 08:32:02 -0500

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.

See Our Related Blog Posts:

Proper Senior Care Planning Needed to Prevent Elder Financial Abuse

New Chairperson of Assembly Committee on Aging Discusses New York Elder Care

Another Study Emphasizes the High Costs of Long-Term Care

Tue, 24 Jan 2012 11:12:20 -0500

target="_blank"

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.

See Our Related Blog Posts:

Nonprofit Innovators Try to Shift Senior Care Away From the Nursing Home

New York Long-Term Care Near the Most Expensive in the Country

Elder Caregivers Found To Have Higher Levels of Stress & Health Issues

Fri, 20 Jan 2012 08:25:05 -0500

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."

See Our Related Blog Posts:

Long-Term Care Insurance is Key Medicaid Strategy to Protect Assets & Allow Home Care

Hire Your Children For Caretaking Duties

Elder Law Issues with Second Marriages

Wed, 18 Jan 2012 10:09:15 -0500

Our New York elder law estate planning lawyers understand that handling long-term planning issues can be particularly delicate when there are second marriages involved. However, it is in these situations, with blended families, when this sort of planning is absolutely critical. Many adult children have natural concern when their parent remarries. Obviously there are inheritance planning issues, and it is vital that seniors who remarry make their wishes very clear about who they'd like to receive what. Failure to do so opens the door to strong disagreement and infighting between those involved. The family glue can come undone even among blood relatives, and there are often even less ties keeping fights in check when blended families are involved.

Beyond inheritance issues, local families should also take note of the New York elder law concerns which are implicated by second marriages and blended families. Decisions about naming a Health Care Proxy and Power of Attorney in the event of disability can present some disagreement when seniors remarry.

An article this weekend in the Laurel Leader-Call referred to another issue regarding the long-term care planning problem in the context of second marriages. The story discussed two seniors who met at an assisted living facility, fell in love, and married. Eventually one of the partners began a physical and mental decline and needed to be moved to a nursing home. The couple did not realize that Medicaid could have been applied for to help support those nursing home costs. If the partner whose health deteriorated passes away, their life savings may be entirely exhausted in providing for the long-term care. As a result, the surviving spouse is often left in dire straits when his or her own health deteriorates and they have a need for skilled nursing care. What often happens is that adult children are forced to scramble in crisis mode to figure out how to pay for the care the elder needs. A range of issues are present when those adult children are step-children who may not have as close a connection with the senior.

Blended families and second marriages raise a variety of concerns that should be accounted for by prudent families. Both estate planning and elder law issues are raised. The issues are often complex, and so professional help is always advisable. It is particularly important to ensure that the professional which is sought out has experience in both areas: elder law and estate planning. Failure to account for disability and long-term care issues may make inheritance and tax planning ineffective (and vice versa). All parts of the planning must work together to ensure that they are effective at the moment when they are needed.

See Our Related Blog Posts:

New York Inheritance Issues in Second Marriages

Surviving Spouse's Use of the Home in Second Marriages

New Book on Elder Law Through the Ages: "Someday All of This Will Be Yours"

Fri, 13 Jan 2012 10:26:06 -0500

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.

See Our Related Blog Posts:

Nonprofit Innovators Try to Shift Senior Care Away From the Nursing Home

New York Long-Term Care Near the Most Expensive in the Country

Paying for Skilled Nursing Care: Medicare & Medicaid

Wed, 11 Jan 2012 09:32:51 -0500

Confusion often reigns when one learns that a family member will likely need long-term skilled care. Finances are always an issue. With the average stay in a local nursing home running $11,000 per month, our New York elder law attorneys are acutely familiar with the financial challenges facing local families at these times. Few can afford to pay those costs out of pocket. Without long-term care insurance (expensive in its own right), most families instead turn to Medicare and Medicaid for support.

Many seniors on Medicare get understandably confused when trying to determine what long-term care is provided by the program. The short answer is: very little. The Centers for Medicare and Medicaid Services have produced a handbook entitled Medicare Coverage of Skilled Nursing Facility Care which is a good starting point for those hoping to learn more. In general, the takeaway is that Medicare will only pay for certain skilled nursing stays and never for those staying longer than 100 days. The first 20 days of qualifying care are covered completely, while anything more (up to 100 days) often requires some sort of copayment. To even qualify for that care a resident must have a qualifying hospital stay, need the care immediately after the hospital stay, and meet a few other requirements.

Conversely, Medicaid is the joint state and federal program that provides the most support for extended nursing home stays. That is why on the elder law side of our practice our New York Medicaid attorneys work closely with local seniors to help them apply for the program and save their assets from being consumed in the qualification process. Unlike Medicare, Medicaid is an income-based program, meaning that local seniors will have to show specific financial need before receiving the help. The application process which takes all of this into account has complex asset and transfer rules. Because it is a joint state and federal program, the qualification process is different in each state.

There are actually two forms of Medicaid: Community and Chronic Care. As the name implies, Community Medicaid is much different in that it provides certain resources for individuals who wish to remain at home in their community. When that is no longer an option and close nursing home care is needed, then Chronic Care Medicaid comes into play. It is this form of Medicaid that has a "five year look back" period for assets and transfers. That means that if assets--a home, stocks, savings accounts--were handed over to another within that period, the value of those transfers may take the form of a penalty period where Medicaid services will not be provided. However, there are various strategies that can be employed to protect against the loss of all of one's assets while qualifying for Medicaid. This is true even if one is on the nursing home doorstep. Professionals in the area will be able to explain those strategies and decide on the right course in your case.

See Our Related Blog Posts:

New York Medicaid Planning Attorney Shares Information on Medicaid Application Process

New York Estate Planning Attorney Shares Common Estate Planning Mistakes

New York Elder Law Attorney Explains "Common Sense" of Protecting Assets from Elder Care

Mon, 09 Jan 2012 10:01:01 -0500

Yesterday our New York elder law attorney Bonnie Kraham Esq., had another article published in the Times Herald-Record. In the piece Attorney Kraham explains how it is common sense for middle class families to work to protect their assets from long-term care costs. The basic idea behind asset protection for seniors is simple: take advantage of legal tools so that assets can be passed down to children instead of lost to pay for long-term care. The wealthiest families have been using these strategies for decades, but more and more middle class families are coming to appreciate the benefits of protecting assets that have often taken a lifetime to accumulate.

As Attorney Kraham explains in the story, long-term care costs are high everywhere, but they are particularly significant in New York--roughly averaging about $11,000 per month. At the end of the day there are only three ways to pay for those costs: (1) out of one's own assets; (2) via expensive long-term care insurance; (3) through Medicaid. Few community members can afford long-term care insurance and most only have personal assets to pay for these costs for a limited time. That is why our New York elder law attorneys work with families by using available tools under the law to protect assets in these situations. The goal is to help families receive Medicaid assistance without losing their personal assets in the process.

To accomplish this goal Medicaid Asset Protection Trusts (MAPTs) are often created. Assets are then moved into the trust. Those assets can be protected from being taken to pay for long-term care costs. Government officials specifically designed the system to allow for such planning. For example, there is a five year "look back period" during which the government will evaluate to see if certain asset transfers were made. Those transfers will trigger a penalty period whereby Medicaid payments will be withheld. However, if planning is done beyond that five year window, then all assets can be protected without any such penalty.

A few have questioned the morality of asset protection. It is important to keep these New York elder law asset protection strategies in context. Asset protection measures have been used in various capacities for centuries. Estate taxes are routinely guarded against, and corporations shield personal assets from private ones. It is not be surprising or unfair for middle-class families to use the same strategies to pass on the fruit of their labor to the next generation.

See Our Related Blog Posts:

New York Long-Term Care Near the Most Expensive in the Country

Elder Law Estate Planning Documents Explained by New York Elder Law Attorney

Happiest Nursing Home Staff Members Work at Nonprofit Facilities

Thu, 05 Jan 2012 11:00:20 -0500

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.

See Our Related Blog Posts:

Tips for Choosing the Best Elder Care for Loved Ones

Nonprofit Innovators Try to Shift Senior Care Away from Nursing Homes

Advocates Call for More GLBT Friendly Senior Housing Options

Tue, 03 Jan 2012 10:25:43 -0500

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.

See Our Related Blog Posts:

Same Sex Couples and The GLBT Community

New York Elder Center Opens for GLBT Seniors

New York Elder Care Advocates Claim Senior Financial Exploitation at Crisis Levels

Thu, 29 Dec 2011 09:03:47 -0500

Elder financial abuse is fast becoming a national crisis. That is the message that a New York geriatrician and social scientist is spreading after conducting extensive scientific investigations into the extent of fraud and financial exploitation among local seniors. The doctor is encouraging friends, family members, caregivers, New York elder law attorneys, and others to keep a close eye out for the signs that this abuse might be occurring among seniors that they know.

As reported in the Centre Daily Times, the doctor's latest work suggests that literally millions of seniors are victimized financially each and every year. Yet only a fraction of the instances of abuse ever come to the attention of authorities--only one in forty four, according to the report. In even fewer cases are the wrongdoers held accountable for their conduct. Previous work by this same team of researchers also found that those seniors who had been abused financially saw similar damaging effects on their physical well-being. The groundbreaking work revealed that mortality rates of elderly victims of financial abuse were significantly higher than for those who had not been abused. Suffice to say, this mistreatment has profound effects on the lives of victims and all efforts to limit the problem must be taken.

Yet, there is a long way to go before the mistreatment is stamped out. According to the latest research at least 2.5 million seniors are victims of financial abuse each and every year. Even then, that number may be a significant understatement. For one thing, it was reached mostly via self-reporting. Many seniors might hide their situation out of fear or embarrassment. Additionally, the research team noted that seniors who were suffering from a severe rate of mental decline were not polled in the survey. Yet it is that very group which is at the highest risk of being victimized by unscrupulous individuals willing to take advantage of them for personal financial gain.

Visiting a New York elder law attorney before a loved one with cognitive mental diseases, like Alzheimer's, loses the ability to communicate is essential. The professional will be able to provide an extra set of eyes on the senior's books which may help catch irregularities or signs of financial abuse. Beyond that, having an elder law estate plan put in place will help keep the senior's wishes fulfilled, even if they lose their mental capacities. Substitute decision-making documents will also be crafted to provide for the best interests of the elder as the disease progresses. These include creation of a Power of Attorney and Health Care Proxy. All of this will help avoid costly, timely, and stressful guardianship proceedings through the court system.

See Our Related Blog Posts:

Proper Senior Care Planning Needed to Prevent Elder Financial Abuse

Authorities Often Act Too Late to Prevent Elder Financial Abuse