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Making the Home Safer for the Senior Resident

Thursday, July 25th, 2013

Many older people require the assistance with daily needs and safe environment that are found in an assisted living facility. Others prefer to age in place, bringing health care assistants into the home. In these cases, changes may also be needed to make the home safer for the senior resident.

Seniors may have trouble moving about or be at risk for falling. Improvements can be made to the home to make life easier, but older people or their adult children may not be aware of what changes can or should be made. An occupational therapist can be of great service, with some specializing in performing an analysis of the home environment and producing a detailed improvement plan that a contractor can follow.
There are some simple and inexpensive changes that can be made, such as installing brighter light bulbs and removing rugs that may cause slipping. More extensive safety features that may need to be installed can include grab-bars for walking assistance or an electric stair lift to get from one level to another easily and safely. Seniors may also need for the height of chairs to be increased slightly to make them easier to get in and out of.

When it comes to paying for such improvements, long-term care insurance can help. If you have such a policy, and it covers home improvements, then hiring an occupational therapist can help in demonstrating that the changes are necessary for the resident’s health. A reverse mortgage or home equity loan can also help pay for safety improvements, but consult with a financial adviser before taking out such financing.

 

For more information about our legal services for seniors, visit www.elderlawnewyork.com

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Mobile Lifestyle Can Have A Legal Impact

Monday, June 17th, 2013

By Bernard A. Krooks, Esq.

Many New Yorkers have embraced a decidedly mobile lifestyle. They think nothing of seasonal migrations in search of temperate weather. Their families may be far-flung, prompting frequent out-of-state visits or they may be trying out a potential retirement spot. We account for the highest percentage of Florida’s temporary residents, often opting to call it home.

But while it’s simple to buy a plane ticket and have the mail forwarded, legal documents don’t always cross state lines so easily. Differences in state law can have big implications for estate planning and long-term care. In some cases, one jurisdiction may not even recognize documents drafted elsewhere due to differences in execution requirements. And you could face unexpected tax bills as governments struggle to fill their depleted coffers.

Generally speaking, spending 183 or more days per year in a location will make you subject to local residency requirements. If you maintain your legal residence in one state for purposes of voting and taxation, but spend significant time elsewhere, it pays to do some contingency planning.

At a minimum, you should discuss your residency situation when you meet with your attorney to review your will, trusts and other important estate planning instruments. It may be wise to consult an attorney in each state to ensure that you’re in compliance with all regulations and that you take full advantage of any favorable differences. I’ve had an increasing number of clients ask about the benefits of having attorneys collaborate across jurisdictions. Parents had begun spending more time in Florida, or due to frailty, were moving back to New York to be closer to family, and they didn’t want to suddenly discover that careful estate planning had been rendered invalid.

While a well-drafted trust can stipulate that it be administered according to the laws of the originating state, it may not be advisable to have one state interpret the statutes of another. Other documents may prove even more challenging. An advance directive can become entangled by something as seemingly trivial as the number of witnesses to your signature. As a result, doctors and hospitals may fail to respect living wills or health care proxies. Banks may not recognize financial powers of attorney. The result could be chaos when you’re least prepared to cope.

Probate, the procedure through which property is transferred to heirs, poses more questions. This process typically takes place where the decedent was domiciled, but if real estate is owned in more than one state, probate must be initiated in each location, possibly involving different deadlines. Even if the decedent was legally resident elsewhere, states have been known to claim estate taxes when local ties were extensive enough.

Over 70 percent of New York nursing home expenses end up being covered by Medicaid, but eligibility and covered services vary by state. So it pays to understand how to navigate the system where ever you or your parents plan to spend your senior years. In addition, there’s growing interest in “filial responsibility” loans, under which adult offspring could be held accountable for the older generation’s expenses. So if Mom or Dad suddenly requires nursing home care that isn’t covered by Medicaid-even for a few months- a son or a daughter could suddenly become liable for huge bills. While New York does not currently hold adult children liable for their parents’ nursing home costs, in a recent case in Pennsylvania, a court held an adult son responsible for his mom’s nursing home expenses.

Since Florida has no state income tax, it could be tempting to declare yourself a resident if you pass the 183-day test, but New York is particularly aggressive about claiming taxes from individuals with connections here. You need to take steps to relinquish your New York residency, including the divestiture of real estate holdings. New York residency audits are on the increase, and you’ll bear the burden of proof, including documentation of how long you’ve spent where. Failure to present a compelling case could leave you responsible for state taxes.

Don’t let legal snarls complicate your chosen lifestyle. A second home and carefree travel are often the fruit of a lifetime’s effort. With a little research and planning, you can avoid untimely complications.

 

For more information, visit www.elderlawnewyork.com.

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Considering Long-Term Care Insurance

Wednesday, May 15th, 2013

In planning for retirement, it is important to consider what would happen if you needed assistance with daily living over a long period of time. Most people in that situation would prefer to be able to stay in their own home with the assistance of a home health-care aide rather than move into a nursing home. But would you be able to afford it? In facing this question, many people are considering long-term care insurance.

People with lower incomes can rely on Medicaid for help with long-term care, and wealthy people will likely be able to afford the cost of care on their own, or pay high insurance premiums if they choose. It is people with middle incomes who must decide whether long-term care insurance makes sense for their situation, with money being the key factor. Long-term home health care is expensive, but so is long-term care insurance.

The American Association for Long-Term Care Insurance reports that an average 60-year-old couple purchasing a policy today would pay over $3,700 per year for benefits totaling $162,000 each, which would increase to $329,000 each by the time they reach the age of 85, due to inflation protections in the policy. That is up 10 percent from the premium price just one year ago. Policies without inflation protection are available for lower premiums, but the benefits available do not increase with time, so policy holders would likely still have to pay for some costs out of pocket.

Long-term care insurance can cover the cost of assistance with daily living at home or in a nursing home or assisted-living facility. The insurance can also give peace of mind to your children, who may be faced with how to make financial decisions in your best interest.

 

For more information about our elder law services, visit www.elderlawnewyork.com.

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Senior Apartments: An Option For Active Independent Elders

Tuesday, April 23rd, 2013

Our latest guest post has been written by Joe Nevins, the Administrative Coordinator at Kittay House

When considering living options for elders, there are choices beyond nursing homes and assisted living facilities. Senior Apartments allow elders to live independently and to have an active vibrant community around them.  In a Senior Housing setting there will be elders who are still working or volunteering, as well as those who need extra help managing and make individual arrangements for support services.

Senior housing is all about community. At Kittay House Senior Housing, for example, tenants can be involved in activities as diverse as the city itself – from trips to Shakespeare in the Park, the Culinary Institute, New York’s Lower East Side or the Apple Store to visits from local artists and entertainers, on-site movies, lectures and workshops, and even live broadcast from the 92 Y.  Meals can be shared (Kittay House offers three daily meals included in the monthly fee).
Physical well-being is another important aspect of senior apartments. Tenant units should be equipped with emergency call bells, and senior-friendly physical activity should be available.  At Kittay House, tenants may participate in a walking club, in movement classes, Yoga, Tai Chi or a special falls prevention series, all designed to help seniors stay fit and active.
Of course convenience is important, too.  Tenants in senior apartments appreciate the housekeeping and linen services – at Kittay they’re included in the fee – as well as proximity to transportation, shopping and medical services.  Kittay, conveniently located near public transportation, has on-site medical professionals and is across the street from the VA Hospital.

For seniors who are still active – working, volunteering, involved in cultural pursuits senior apartments offer community and convenience.  If you’d like to consider senior housing, contact Director Arlene Richman at (718) 410-1441 or read more at http://www.kittayhouse.org.

For more information, visit www.elderlawnewyork.com.

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Paying for Long-Term Care at Home

Monday, April 15th, 2013

By Susan Yubas

Receiving long- term care is expensive.  If you or your loved one wants to stay at home but requires assistance to function, how will you pay for it?

Medicare determines whether or not care provided at home will be covered based on whether or not the type of care required is considered medically necessary, or is considered to be more supportive in nature.  Medicare calls this type of supportive care “custodial” care.

Custodial care includes support and assistance with activities of daily living (also called ADLs), which include a range of activities from shopping, light housekeeping, and laundry to meal preparation, dressing, bathing, toileting, and help transferring to or from a chair or bed.  These services do not require the skills of a nurse, and are usually provided by companions and home health aides.  Medicare can cover medical social services, some medical supplies and durable medical equipment like a wheelchair or walker. Each of these requires a referral or prescription from your doctor.

When you need custodial care to help with bathing, dressing, and assistance with household chores, you will have a choice between hiring help through a Medicare certified agency or hiring an independent caregiver on your own. There are pros and cons of each, and you will want to consider the different options in your community.

Long-term care insurance is an option that can help provide a way for you to pay for this care. There may also be community services available that will supplement in-home care and help you make the most of your financial resources.

Skilled care is usually provided by licensed professionals such as nurses and physical and occupational therapists and may also include social workers, some laboratory services and medical equipment. These services, provided under the supervision of a doctor, are considered to be “medically necessary.” Sometimes, this type of care is needed at home when a patient is discharged from a hospital and is part of a treatment plan of care ordered by your doctor.  Examples of skilled care include wound care, tube feeding, respiratory therapy and the administration of IV medication.

Get more information on Medicare coverage for home health services here.

Medicaid provides coverage for some long-term care services at home and in the community. Eligibility for Community Based Medicaid is determined by income, resources, age, and disability levels.  Medicaid can pay for a number of medical services that can help you continue to live in your home, including home care, personal care aides, adult day care, physical, occupational and speech therapy, and medical equipment such as wheelchairs  The need for these services must be certified by a physician and you must receive these services from a Medicaid certified provider.

Get more information about Medicaid eligibility for long-term care here.

Again, it is important to think about long-term care, regardless of whether it is provided at home or in a residential facility, before care is needed.  Deciding how and where you receive care is a major decision and it is important to examine all of your options and choices.

Susan Yubas is Director of Business Development at The Bristal Assisted Living.  She is also a Certified Senior Advisor and the founder of FYI Senior Living Solutions, Inc.
For more information, visit www.elderlawnewyork.com.

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Choosing the Best Residential Options for Seniors

Monday, March 25th, 2013

By Susan Yubas

While there are lots of reasons that an older person may decide to move from their home, a main reason for considering a move is the social isolation that can be common among seniors. Often, older adults find that their social network has diminished and it can be very difficult to initiate new friendships especially if they are no longer driving and do not have access to good public transportation.

Being house bound without social contacts can cause loneliness, anxiety, and depression. While more and more seniors are using personal computers and Skype, social isolation remains a problem.  Moving to a residential community can help.

Many families do not have a clear understanding of the types of residential options available and often confuse senior living residences and assisted living with nursing homes. Others think they must require a lot of assistance in order to move to a senior community.

Senior Residential Living may or may not provide hospitality or support services. Under this living arrangement, senior adults, generally those aged 55 and over, lead an independent lifestyle that requires little or no assistance.  These communities are usually rental apartments or townhouses where residents have complete choice as to whether or not to participate in any services or programs that may be offered.

Independent living refers to housing designed exclusively for seniors who require little or no assistance with the activities of daily living.  Geared to older adults who enjoy some degree of socializing and community activities, these communities usually offer services for residents such as housekeeping, laundry and meals and opportunities for social events.  If residents require home health care services they are usually arranged for by the individual resident, provided by an outside agency and paid for privately.  These residents pay a rental rate or monthly fee.

Continuing Care Retirement Communities (CCRCs) may be an option if you or your spouse are relatively healthy now, but anticipate significant health problems in the future.  These communities offer a continuum of care from independent living to assisted living to skilled nursing home care on the same grounds. Many have their own home care agencies to provide services to community residents.  CCRC’s normally require a one-time entrance fee and monthly service fees thereafter.

Assisted living communities are designed to provide individuals with assistance with basic activities of daily living such as bathing, grooming, dressing, and transferring.  They may offer medication assistance and/or reminders.   Assisted living communities do not provide 24 hour skilled nursing care.  Usually, assisted living communities offer their residents prepared meals three times a day and help with light housekeeping and laundry.  As with Independent Living, communities will also plan events, activities and trips that residents can participate in.  Some communities recognize that being able to keep a pet is very important to the resident, and will allow the senior to bring a pet as long as he or she is able to take care of it.

In New York State, Assisted Living communities that provide services for individuals with Alzheimer’s disease or dementia are called Special Needs Assisted Living Residences or SNALRs.  SNALRs staff members are specifically trained to work with individuals who have some form of dementia. It is important to find out what level of care is provided, as some assisted living communities will accept individuals with Alzheimer’s or related dementia through the entire disease progression and others will only accept individuals who are in the early stage of the disease.

Assisted living is usually paid for privately, but some long-term care insurance policies cover licensed assisted living.   New York State offers Medicaid funds to help with assisted living costs through the Assisted Living (ALP) program, but there are a limited number of ALP communities.  Most assisted living residences charge on a month-to-month lease arrangement based on the level of assistance required, but some require long-term arrangements.

Nursing homes are for those individuals who require care around the clock and at a much higher level than those who reside in an assisted living community. Skilled nursing facilities provide care of both chronic conditions and short term rehabilitative or sub-acute care as ordered by a physician.   Sometimes people are admitted for short time following hospitalization.  Parts of a nursing home stay are usually paid for by Medicare following a hospital stay, and then either by a family’s own funds or long term care insurance. If an individual is eligible for Medicaid, that program will pay for skilled nursing care.

Choosing the right residential setting for your loved one is an important decision and should consider lifestyle preferences, health care needs and financial implications.

Susan Yubas is Director of Business Development at The Bristal Assisted Living.  She is also a Certified Senior Advisor and the founder of FYI Senior Living Solutions, Inc.

For more information, visit www.elderlawnewyork.com.

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Some New York Nursing Home Evacuees Still Displaced

Tuesday, February 5th, 2013

After Hurricane Sandy, hundreds of disabled and elderly New Yorkers were evacuated from assisted living facilities and nursing homes near the coast.  Now, more than two months after the storm hit, some evacuees are still getting by in temporary quarters.

The evacuees were moved to places like Brooklyn’s Bishop Henry B. Hucles Episcopal Rehabilitation and Skilled Nursing Center.  The center was already operating at capacity before the storm hit and is now packed with more than twice the number of residents it is licensed to care for.  One hundred ninety patients from the Rockaway Care Center in Queens, which flooded due to the storm, have had to sleep on cots in multi-purpose rooms and in the center’s chapel.

About 160 residents of an assisted living facility in Queens called Belle Harbor Manor had to be evacuated to the grounds of the Creedmor Psychiatric Center, a partly-unused mental health facility.  The evacuees complained of being mixed in with patients suffering from severe mental disorders, and losing freedoms such as the ability to have visitors in their rooms.

According to New York’s Health Department, more than 6,200 people were evacuated from 47 different nursing homes and assisted living facilities as a result of Hurricane Sandy, and storm damage has meant that about a dozen were still closed two months later, with others only able to accept a limited number of residents back.

The majority of patients were evacuated after the storm, under flood conditions, and were unable to bring extra clothing and personal belongings.

Officials said it may be weeks before facilities with some of the worst flood damage are able to re-open.

For more information about our elder law services, visit www.elderlawnewyork.com.

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For End-of-Life Care, Many Must Choose Between Nursing Home and Hospice

Tuesday, January 15th, 2013

According to a recent study released by the University of California, San Francisco, close to one-third of elderly people needing end-of-life care enter a nursing home. The issue? Nursing homes are not always the best environment for end-of-life care. A nursing home is equipped to oversee many basic elements of end-of-life care, including IV hydration and monitoring vital signs, but staff may not be adequately responsive to issues such as pain management, palliative care and support for bereaved family members.

The study used data from 1994 through 2007 from the National Health and Retirement Study. Researchers examined more than 5,000 cases of people who lived independently. Some 30 percent of individuals older than 85 eventually used their Medicaid skilled-nursing facility (S.N.F) benefit within the final six months of their life.

Care options are limited for those with tight budgets. While some end-of-life nursing home residents can receive hospice care in a nursing home, Medicare seldom reimburses for the room and board provided by the facility as well as hospice care. Residents must choose – and nursing home room and board can add up to hundreds of dollars per day.

An individual can choose to have home hospice care and use those Medicaid benefits, but if there are any “medically complex” issues, home hospice may not cover those expenses. Additionally, home hospice assumes there are family members and a home where care can be given. An individual who needs 24-hour care may have to choose between skilled care and hospice care. But for many, the need of 24-hour care outweighs other options. Complicating matters further is the way Medicare restricts coverage: if an individual is hospitalized for a diagnosis unrelated to the hospice diagnosis, he or she can often get nursing home and hospice coverage.

For more information, visit www.elderlawnewyork.com.

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Elder Law Attorney Bernard A. Krooks to Speak at Heckerling Institute

Monday, January 7th, 2013

White Plains, New York (January 10, 2013) – Bernard A. Krooks, Esq., a founding partner of Littman Krooks LLP, will be a guest speaker at the 47th Heckerling Institute on Estate Planning on January 14, 2013, at the Orlando World Center Marriott Resort and Convention Center, in Orlando, Florida.

Mr. Krooks will be speaking about the “graying” of Baby Boomers and their need for elder law services. Mr. Krooks will also discuss “Later Life Law” and how elder care attorneys can assist their clients with Medicaid options as well as other areas of elder care planning including retirement accounts, long-term care insurance and tax considerations and the use of trusts in elder law and special needs planning.

The Heckerling Institute on Estate Planning is known as the premiere U.S. conference for estate planning professionals, including attorneys, accountants, trust officers, insurance advisors and wealth management professionals. The program offers lectures and special sessions with comprehensive coverage of estate planning techniques and strategies, designed to allow attendees to customize their educational experience.

Mr. Krooks has been included among The Best Lawyers in America® for each of the last six years. He has been selected as a “New York Super Lawyer” since 2006. Krooks has received his AEP accreditation from the National Association of Estate Planners & Councils. He is a member of the Real Property, Probate & Trust Law Section and Tax Section of the American Bar Association. He is a sought-after expert on estate planning and elder law matters and has been quoted in leading publications such as The Wall Street Journal, The New York Times and Forbes, among others.

About Littman Krooks

Littman Krooks LLP provides sophisticated legal advice and the high level of expertise ordinarily associated with large law firms along with the personal attention and responsiveness of smaller firms. These ingredients, which are the cornerstone of effective representation and are necessary to a successful lawyer/client relationship, have become the foundation of the firm’s success.

Littman Krooks LLP offers legal services in several areas of law, including elder law, estate planning, special needs planning, special education advocacy, and corporate and securities. Their offices are located at 399 Knollwood Road, White Plains, New York; 655 Third Avenue, New York, New York; and 300 Westage Business Center Drive, Fishkill, New York. Visit the firm’s website at http://www.elderlawnewyork.com.

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Impending Changes Would Make Estate and Gift Taxes Apply to Many More Americans

Wednesday, December 26th, 2012

The rules governing taxes on gifts and estates are set for major changes at the end of the year unless Congress steps in.

The taxes, which currently concern mainly the very wealthy, will soon ensnare far more people if scheduled reductions in exemptions are allowed to go through. The exemption level for each tax is currently $5.12 million and is set to plunge to $1 million.

The lifetime exemption on gift taxes is also scheduled to make an identical drop.

The impending changes have prompted a frenzy of activity among wealthy Americans eager to make gifts and create trusts under current law, filling the calendars of estate planning attorneys and financial planners nationwide.

The estate tax rate is also scheduled to increase from a current top rate of 35 percent to a new top rate of 55 percent.

According to Congress’ Joint Committee on Taxation, the change in estate tax exemptions would make approximately 55,000 estates subject to the tax next year, compared to fewer than 4,000 estates under current law.

President Obama’s budget proposal of February 2012 called for an estate tax exemption level of $3.5 million and a top rate of 45 percent. It did not contain a recommendation for gifting exclusions.

Estate and gift taxes are not the only ones scheduled to change. The tax exemption for generation-skipping transfers and trusts would likewise drop from its current $5 million to $1 million under current law. In addition, trusts of this type currently can shelter assets from taxation for an unlimited number of generations, but President Obama has proposed limiting the effect to 90 years.

Most experts predict that Congress will not resolve the matter before the end of the calendar year, but any compromise reached in 2013 could be retroactively applied to January 1.

For more information, visit www.elderlawnewyork.com.

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