Elderly Care: When An Aging Parent Needs Emergency Care

July 16th, 2013

The American College of Emergency Physicians (ACEP) has released tips for the adult children of elderly parents who find themselves facing a medical crisis. The emergency room can be a daunting experience. These tips may make the experience slightly less stressful.

When possible, the caregiver or accompanying adult should bring to the emergency room a completed Medical History Form. The form should list any allergies, the medications the elderly person is taking, and both past and current medical conditions. This form should be given to the intake attendant.

In addition to the Medical History Form, have on hand a list of the medical health professionals the elderly patient sees, such as cardiologist, oncologist, etc. Have their names and contact information written down, as well as the reasons for their care and how long the elder has been under their care. Also include any information about recent surgeries, such as pace makers or hip replacements, and include complete insurance and identifying information.

The emergency physicians also suggest that any caregiver or attending adult bring a change of clothing and personal items, and should expect that the elderly individual will be admitted for overnight or extended care. While this may not happen, arriving prepared will save time and effort later. The items can always be left in the car “just in case.” Also, caregivers may wish to bring reading material to pass the time while the patient is waiting to be seen or for test results. Elderly patients make take longer than expected to have a complete workup, especially if they have multiple issues or complaints which must be investigated.

The ACEP also suggests that the caregiver clarify to the attending physician if the patient’s state of mind is altered or if he or she is confused. If the caregiver is given information and instructions, he or she should share that information with the patient; work to keep them informed and allow them to make their own medical care choices.

Many elderly patients downplay their symptoms when in the ER, doctors report. Be prepared and willing to clarify with additional information, if needed.

And long before that trip to the ER is a possibility, they say, consider discussing with the elderly parent about the possibility of their drafting a living will. When in the midst of tough decision-making such as when the condition is a life-threatening one, it can make a significant difference in how family members approach some choices that must be made.

 

For more information, visit www.elderlawnewyork.com.

 

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Phrasing Affects Do Not Resuscitate Choices

July 10th, 2013

 

Researchers at the University of Pittsburgh recently studied what factors affect the decisions of people who are designated health care surrogates for a loved one. The researchers showed 252 people a video simulation of an actor posing as a doctor appraising them of a certain health condition and asking whether the patient should be resuscitated. They found that the way information is phrased makes a significant difference in what the health care surrogate chooses.

The study, developed in part by Dr. Amber Barnato and published in Critical Care Medicine, found that two factors made the biggest difference in the decision. One factor was whatever the health care surrogate believed other people in the same situation had chosen. When people were told that most people want CPR to be performed if the patient’s heart stopped in a certain situation, 64 percent also wanted CPR to be tried. If they were told that most people do not choose for CPR to be performed, then only 48 percent chose CPR.

The other significant factor was whether the “doctor” in the video used the phrase “allow a natural death” rather than the phrase “do not resuscitate.” When the latter phrase was used, 61 percent chose for CPR to be performed, but that figure dropped to 49 percent when the phrase “allow a natural death” was used.

Other factors had little effect. Expressions of sympathy from the “doctor,” being shown a photo of the loved one, or being asked to think about the choice from the perspective of the loved one all made little or no difference in the choice.

 

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How to Become a Caregiver Coach in Westchester County

June 28th, 2013

Westchester County has introduced a new initiative to train volunteers to become caregiver coaches. This is a unique way to volunteer your time to help local families and contribute to an innovative community project.

Few people are prepared to become caregivers to a disabled or elderly loved one, and people who are thrust into the role of caregiver often feel overwhelmed. A caregiver coach is someone who is trained by professionals to give individual support to family caregivers. This support can be essential to helping caregivers understand their responsibilities and make informed decisions.

The Livable Communities Caregiver Coaching (L3C) Program is an initiative of Westchester County’s Department of Senior Programs and Services. The program aims to form a corps of volunteers who have been trained in caregiver coaching skills and can provide services to family caregivers. The initiative is part of an overall goal of supporting seniors in living with dignity and independence in their own homes.

Westchester’s caregiver coaching program is the most comprehensive in the nation, which is appropriate for the county with the fastest-growing population of seniors in the country. Today one in five Westchester residents is age 60 or older, and the majority of these seniors have a disability of some kind. It is estimated by the Westchester planning department that by 2030, people over the age of 60 will represent 25 percent of the county’s population.

Anyone may volunteer to be a caregiver coach. Experience as a caregiver is helpful but not necessary. The ideal caregiver coach is an empathetic, nonjudgmental person who wishes to help others. Volunteers will receive approximately 12 hours of training spread over three weekly sessions. A one-year commitment is required. Coaches will also participate in a monthly conversation where challenges and information will be shared about caregiver coaching experiences. Coaches will learn about the aging process and the responsibilities that caregivers face, as well as how to convey factual information clearly. As caregiver coaches, volunteers will share information and listen to caregivers’ concerns, while refraining from offering legal or medical advice.

If you are interested in volunteering to become a caregiver coach, contact the Department of Senior Programs and Services at 914-813-6441 or visit their website: http://seniorcitizens.westchestergov.com/caregiver-coaching/

 

 

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Mobile Lifestyle Can Have A Legal Impact

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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Planinng for Life’s Unexpected Twists and Turns

June 4th, 2013

By Susan Yubas, Director of Business Development at The Bristal Assisted Living, Certified Senior Advisor, Founder of FYI Senior Living Solutions, Inc.

Most of us do not get around to having that all important conversation with loved ones, and if we do, it is at the worst possible time and under the most stressful conditions.

An acquaintance of mine in her early forties was recently hospitalized following an automobile accident in which there was no other car involved.  An otherwise healthy, active woman who was not texting or talking on her cell phone while driving, her husband and I waited to hear what could have been the cause.  Did she have a stroke, a seizure, a heart attack?

As we sat together, he asked “What if she doesn’t pull through?  Or has physical or cognitive issues?  What if she can’t go back to work? Can we afford to live on one income, especially if she needs help? We never talked about this.  We never talked about the “what if’s.” I don’t know what she would want me to do or what would be best!”

In my practice, I primarily work with older adults and their families as they prepare for and deal with the life transitions that happen with aging.  But, the reality is that planning is not age related.  Denial is just so convenient.   We have all the time in the world to “get to it” and we’re young and healthy.  We may get old, but will never be “elderly.”  If we are, there will always be someone around who knows what our wishes are. They will have our best interests in mind.   That person will also be able and willing to implement and execute whatever needs to be done and, of course, there will be enough money to pay for it all.

Or, we made a plan a long time ago and haven’t updated it due to “benign neglect.“ Since then, we’ve moved to another state with different regulations.  We’re no longer friendly with the person we named as Executor in our Will.  Documents may not be titled properly so that our wishes can be granted.  Then, a crisis happens, and you receive that call about a parent who has had a fall, a stroke, or an accident, and life will not be the same.

Several months ago, I met with a couple in their early 70’s at the request of their son who lived out of town.  He couldn’t get his parents to talk to him about their wishes and plans for the future, which they insisted, were all taken care of.  In the course of our conversation, I learned that they had, in fact, made plans for retirement long ago.  Since then, their circumstances had changed significantly,   but they had made no changes in their initial plan.  They were in good health and enjoyed an active, independent life.

Shortly after our initial meeting, the husband started to have problems with his eyesight.   The wife slipped on the stairs, fractured her hip and only wanted to recover at home.  Neither of them could continue to run the business they had built.  Previously capable parents were suddenly not able to think clearly due to the stress of the situation.  The children were angry at their parents for not thinking about how they would take care of each other or for what would happen to their business if they could no longer work.  They argued over what would be the best for their parents and who would be the child responsible for coordinating their care and transition to what would become their “new normal.”

Life does not always go as smoothly as we would hope.  However, when we take the time to plan in an organized and thoughtful manner, we can make difficult situations a little less difficult and hopefully avoid a crisis situation from occurring.

 

For more information, visit www.elderlawnewyork.com.

 

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When Medicare Covers Nursing Home Care

May 28th, 2013

Many Americans of various income levels expect to make use of Medicare for health care costs after age 65. However, it is important to note that Medicare does not pay for care at a nursing facility except in certain circumstances.

First, let’s review what Medicare does cover. Medicare Part A covers care in a hospital and Part B covers outpatient services. For these benefits, there is a choice between traditional Medicare or a network plan, Medicare Part C or Medicare Advantage, in which the government pays for private coverage. Finally, Medicare Part D covers outpatient prescription medications.

So where does nursing home care fit in? Nursing home care is only covered for a limited time if it is necessary after a hospital stay. If a patient is hospitalized for three consecutive days or more and is then admitted to a nursing home within 30 days and a doctor certifies that the patient needs care that can only be provided on an inpatient basis at a nursing facility, then Medicare will cover a stay of up to 100 days. Only facilities approved by the Centers for Medicare and Medicaid Services (CMS) can be covered. If the stay lasts longer than 100 days, then patients are expected to pay for the care out-of-pocket until the point that they become eligible for Medicaid.

The rules above are confusing enough, but their interpretation can get even more complicated. Some families have been denied Medicare coverage for a nursing home stay because the hospital deemed their stay an “observation” rather than an “admission.” In other cases, because a hospital day is usually measured as midnight-to-midnight, patients may believe they have been in the hospital for three days, but find that the hospital measures their stay as less than three days.

To monitor Medicare charges, CMS employs private contractors who receive contingency fees based on the overcharges that they discover, so they are motivated to deny coverage whenever they can.

For a doctor to certify that treatment in a skilled nursing facility is required, the patient must need rehabilitation services for at least five days a week, or skilled services for seven days a week. Services such as, for instance, tube feedings would qualify for nursing home admission. Other services, such as rehabilitation services that could be given 3 or 4 times a week on an outpatient basis, would not be covered.

Even if Medicare covers a nursing home stay, there is only full coverage for the first 20 days. After that, a co-payment is required. These co-payments, and the cost of a nursing home after 100 days, may be covered by Medicare supplemental insurance, if the patient has such insurance and submits a claim.

Many middle-class families, facing the prospect of seeing an older loved one’s life savings consumed by nursing home costs, are turning to trust planning to protect their assets while still allowing them to be eligible for Medicaid. An elder law or estate planning attorney can create a trust for an older person to transfer assets, thus reducing the person’s wealth level enough to become eligible for Medicaid. Another strategy for dealing with nursing home and other long-term health care costs is long-term care insurance. With proper planning, families can manage the costs of a stay in a nursing home.

 

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Planning for Boomers

May 21st, 2013

By Susan Yubas, Director of Business Development at The Bristal Assisted Living, Certified Senior Advisor, Founder of FYI Senior Living Solutions, Inc.

The other day I realized I am exactly two thirds of my mother’s age.  That hit me hard, as I began to think of life as being divided in thirds…and realized that if the first two thirds of my life went by in a blink, then I want this last third to go by very slowly.

The way we look at aging has changed drastically over the years.  People are doing great things in this stage of life, some with assistance, and rather than looking at help as taking away independence, they view accepting assistance as a means to reaching potential – to being everything they can be.  I recently listened to a talk given by the actress Jane Fonda on reaching what she calls life’s “third act.”  She realized that she could control a good part of this time of her life and decided that she was not going to live the old paradigm of aging (think of a bell curve where the start of the curve is birth, the peak is middle age and then it declines sharply to old age,) but rather to view aging as a staircase that you climb to make added years happier, more successful and more liberating.  Think of it – when you are an adolescent, you plan for college, then you plan for your work and your family years.  Why not view the “boomer years” as a time to plan for this next stage of your life and to use those years to make a difference.

Six years ago, a gerontologist at Cornell University started asking older people for their advice towards solving life’s major challenges. Called the Cornell Legacy Project, it asked seniors for their advice as to how to age fearlessly and well.

The researchers were surprised to find that those in the study held a generally positive view about old age. One response came from an 81-year old man: “Embrace it. You still enjoy life, and there’s still purpose in your life. A 94-year old woman suggested: “My advice about growing old? I’d tell them to find the magic.” Old age is very different from what seniors anticipated – and it exceeds their expectations. People felt freer to pursue interests and clearer about their life goals and how they wanted to spend their time. Many described their life after 70 as a quest or an adventure.

There was overall agreement on the importance of maintaining social connections finding meaningful ways to participate in activities in order to assure a positive and enjoyable old age. These relationships and productive roles can be difficult as life transitions such as retirement, widowhood, and health problems occur.  The seniors interviewed for this study suggested that starting around age 60, everyone needs to become aware of the possibility of becoming isolated and take steps to stay involved.

Many seniors also said that the lesson they had learned was to plan carefully for where you will live in old age. Based on their own experience and those of parents and friends, they agreed that younger people should begin to think about living arrangements when they are still active and healthy – both to increase their options for where they can live and also to reduce responsibility and anxiety on the part of their children.  The seniors noted that some people unnecessarily suffer with insecurity, isolation, and inconvenience because they stay in their homes rather than move to a more stimulating environment.

Travel.  Take a class.  Volunteer.  Mentor.  Aging can mean an extended active and productive life.  Most aging Americans do not think that when they retire they will no longer be productive.   Many of us believe old age begins after age 80.  We exercise regularly and eat a healthier diet so we feel years younger than we are.  We envision years and years of health and activity and being able to afford what we want.   We believe 60 is the new 40, and the older we get, the younger those older than us become.  In many cases, we will continue to learn, grow, and find new ways to be productive, creative and relevant.

We still need to think ahead.  Not all of us are really thinking about the time when we may become frail and many of us are very unprepared for that time in our lives.  We have begun to lose our parents and some friends.  Some of us have lost spouses. But we still do not put much thought into about what happens when we are no longer able to be as independent and active as we currently are, even if it is at age 90 plus.

Aging is more of an attitude than a number. This is a time to re-assess what you want from life and what makes you really happy. Know your capabilities and what makes life exciting for you.

Live for today, but remember to plan for tomorrow.

 

For more information, visit www.elderlawnewyork.com.

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Considering Long-Term Care Insurance

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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How Chained CPI Could Affect Social Security

May 14th, 2013

As part of negotiations aimed at reducing the deficit, Congress and the President have considered changes to the way the Consumer Price Index (CPI) is calculated. “Chained CPI,” as the proposed method of calculation is known, could have adverse affects on Social Security benefits, as cost of living adjustments are based on CPI.

Proponents of chained CPI say that the current method of calculating CPI overestimates the real effect of inflation. When prices go up on some items, consumers may choose to purchase something else instead, thus mitigating the effects of inflation. This “substitution bias” is addressed by chained CPI. This technical change would result in lower payments for Social Security beneficiaries.

The proposed change is popular among politicians seeking to reduce the deficit, as it is estimated that there could be a reduction of about $390 billion from the deficit over the first decade, with about one third of the savings resulting from lower Social Security benefits payments.

Of course, Social Security beneficiaries do not want lower payments, and advocates for seniors have pointed out that chained CPI is not appropriate for estimating the cost of living for older people, as many of their expenses, such as medication and health care, are fixed, and therefore not prone to substitution bias. Further, Social Security is financed separately from the rest of the budget, and does not contribute to deficits in other parts of the budget. The bottom line is that seniors who depend on a fixed income are least able to afford cutbacks.

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

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New York Medicaid and Medicare Part D: Working Together

May 8th, 2013

The state of New York has several major public health insurance programs, including Medicaid, commonly known as “Regular Medicaid.”

While Regular Medicaid in New York offers extensive health care services including: dental care; diagnostic testing; home care; hospitalization; mental health support; out-patient care at hospitals and community clinics; and physical therapy, clients of Medicaid in New York must receive their prescription drugs via Medicare Part D.

Any individual currently receiving or about to begin receiving New York State Medicaid must join a Medicare prescription drug plan, or they will lose their Medicaid benefits. When an individual becomes eligible for both Medicare and Medicaid, he or she will automatically be assigned to a Medicare Prescription Drug Plan in order to not miss even one day of coverage. Though a prescription drug plan is mandatory, enrollment in Medicare Part D is not; enrollment in another plan which better meets prescription drug needs is allowed. Patients are able to switch to another plan at any time.

Typically, as part of Medicare Plan D, the patient must pay a nominal amount, like a copayment, for the medication. Individuals who have full coverage from Medicaid while living in a residential home, an adult living or assisted living facility will likely be required to pay a small medication copayment for each  medication. If an individual has full Medicaid coverage and resides in a nursing home, he or she will not be required to pay anything for covered prescription drugs.

Medicare’s State Pharmacy Assistance Program (SPAP) for prescription drug coverage is determined by each state.  New York State’s Medicare’s State Pharmacy Assistance Program may determine that a patient should receive additional coverage when they join the Medicare Prescription Drug Plan, or may require the patient to enroll in a separate state program for prescription payment assistance.

Clients of New York Regular Medicaid must receive health care services through their managed care plan. Regular Medicaid in New York is available to single adults, childless couples at lower income levels, caretaker adults, the elderly, the disabled, and children, subject to some restrictions. Regular Medicaid may also provide retroactive coverage.

 

For more information, visit www.elderlawnewyork.com.

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