A Difficult Decision: Choosing a Nursing Home for Yourself or Your Loved One
February 6, 2012
If and when the time comes to choose a nursing home—either for yourself or for a loved one—how will you know how to choose the right one? A person’s living situation often has a lot to do with how happy they are, so it is important to choose carefully and wisely. When you do begin the process of choosing a nursing home, you don’t have to go into it blind. Here are a few things to consider and questions to ask when you start your search:
A Matter of Money – Nursing care is an expensive prospect, so one of your first considerations when looking for a nursing home will be how much it will cost and how you (or your loved one) will pay for it. Fortunately, it is likely that the entire cost will not have to come out of your personal finances. The Medicare.gov website offers an overview of different strategies to pay for quality nursing care. Your elder law attorney can help you navigate these—and other—options.
For-Profit vs. Non-Profit – Not all nursing homes are created equal, and according to this recent article the choice between a for-profit or non-profit home can be one you’ll want to consider carefully.
Evaluate Staff and Policies – Taking the time you need to evaluate the staff and the policies of the homes on your list will quite possibly be the most important part of your decision-making process. This article from the “Our Parents” website provides a comprehensive list of questions to ask yourself, the nursing home staff, the residents, and more before you make your decision.
Location, Location, Location – Finally, we all know that location is everything, and this is true of nursing homes as well. Issues of location ranging from how close the home is to family and friends, to what kind of view can be seen from the windows can all be of the utmost importance.
Choosing a nursing home may well be one of the most difficult decisions you will ever make, so it’s best to go into it prepared. Don’t be afraid to get in touch with the professionals who can help you make the best possible decision for yourself and your loved ones.
As Elder Population Grows, So Does Need for Awareness of Elder Abuse
January 18, 2012
Elder abuse is a disturbing (and often underreported) issue that will eventually impact all of us—if not on a personal level then most likely by touching the life of someone we know and love. Elder abuse is something that is difficult for most people to consider, not only because the idea is such a disturbing one, but also because it is so insidious.
Elder abuse can be either physical or financial; it can happen to seniors suffering from Alzheimer’s or dementia as well as seniors who still have all their mental faculties; and the perpetrators can be strangers, nursing staff, or even family members. Once you begin to learn about it, it seems that the opportunity for elder abuse can be lurking around every corner.
This recent and disturbing article from PBS Frontline brings to light some of the ways that the medical community itself has managed to overlook or ignore elder abuse whose evidence is right under their noses. “Autopsies of seniors have become increasingly rare even as the population age 65 or older has grown. Between 1972 and 2007, a government analysis found, the share of U.S. autopsies performed on seniors dropped from 37 percent to 17 percent.” What this means is that “coroner and medical examiner offices, which are responsible for probing sudden and unusual fatalities… — hampered by chronic underfunding, a shortage of trained doctors and a lack of national standards — have sometimes helped to send innocent people to prison and allowed killers to walk free.” This may be especially true in cases of elder abuse. It’s clear that something needs to be done.
USA Today reports that not everyone has their heads in the sand. “There is a genuine recognition by those who are concerned by the abuse of elders that there need to be appropriate safe houses for them to get them out of immediate harm’s way… Nationally, we’ve been aware of the need for elder abuse shelters, but they’ve been slow in coming into fruition.” Furthermore, public figures (such as Mickey Rooney) coming forward with their own stories and experiences has helped raise awareness of elder abuse.
For more information about elder abuse and what you can do to prevent it, you can go to the National Center on Elder Abuse website, or contact our office.
A Woman’s Work Is Never Done
January 6, 2012
Do you know who will take care of you when you are unable to take care of yourself? Studies show that most caregivers for aging seniors are likely to be women, and most likely to be your daughter or daughter-in-law. What this means is that unless parents have a plan for their future long term care, the financial burden of caring for these aging parents will fall to daughters and their families.
Serving as a caregiver for elderly parents includes more than just driving to doctor appointments or helping with the shopping, it often includes paying for food and medical costs, as well as taking time away from careers to care for family members. In fact, it’s not unusual for female caregivers to experience a significant loss of income over a lifetime in reduced salary and retirement benefits.
Many seniors think that they will have government programs such as Medicare and Medicaid to fall back on, but these programs don’t always provide as much as expected or hoped. Relying on government programs can leave your children or family members footing just as much of the bill as they would without the programs. Instead, seniors may want to consider investing in long-term-care insurance, which can provide more flexible and comprehensive coverage than government programs, and save seniors and their families much time and money.
If you are a daughter of aging parents, now is the time to talk to your parents about the future. Studies show that you are the one who is likely to shoulder the responsibility of caring for parents as they age. Doing so will affect your family, your career, your finances, and even your health.
The subject of aging and elder care is a difficult one, but not one to be left to the last minute. Talk to your family about your wishes and plans for the future, then bring your estate planning attorney into the discussion. Once you have an idea of your wishes, an expert can help you feel better about your options, and put you on the right path for keeping your family healthy, happy, and financially secure in the years to come.
Who Will Be Making Your Difficult Healthcare Decisions?
December 14, 2011
A recent article in the LA Times reminds us of just how important it is to have some kind of living will or advanced healthcare directive, and that it is absolutely necessary to talk about these things with your loved ones. If you have not done these things it is your loved ones who will be left to make the painful and terrible decisions about your medical treatment and possibly even the heart-wrenching DNR determination.
The author writes of his father—chronically ill, stroke survivor, suffering from mild but advancing dementia—who is currently staying in a nursing home, “where they’ve put him on a diet of pureed foods and thickened liquids, but he often refuses to eat, demanding to be taken home and fed the home cooking he’s always loved. It’s hard to tell him that may never happen, and that his options are increasingly grim. If my dad can’t eat, a feeding tube will be his only choice. Other than giving up the fight.”
The family is now struggling to decide if a feeding tube is the right course of action, what their father would (or does) want, and how involved he should be in the decision considering his current state of mental health. “We worry… that with mild but advancing dementia, my father won’t be able to fully comprehend the implications of being fed through a tube implanted in his gut. And if he declines it, is he competent to make that decision?” These are the heart-breaking decisions that can leave loved ones asking themselves for years after, “Did we do the right thing?”
We often shy away from talking about these issues with our family members and loved ones. We think that they are too sad, too depressing, or too far into the future to worry about yet. The only thing that can make these decisions even the tiniest bit easier, however, is knowing for certain what your loved one would want; and the only way to know for certain is to talk about your feelings with your family, and to put your wishes in writing with a living will or healthcare directive. Our office can help you do this.
More often than not the best that can be hoped for in a situation like the one discussed above is that some measure of peace is attained. We wish this for the author of the article and his family, and we wish this for any of our readers involved in similarly difficult and painful circumstances.
Nursing Home Etiquette to Remember During Holiday Visits
December 5, 2011
Nursing homes during the holiday season tend to see a little more activity than they do during the rest of the year, whether because of families coming to visit loved ones, or local groups or individuals bringing holiday cheer to residents who may not have family living nearby. Taking time to visit with nursing home residents during this time of year can be an immensely rewarding experience for all involved, especially if new or infrequent visitors keep a few simple rules of etiquette in mind:
1. Call the nursing home staff ahead of time to schedule your visit. This not only ensures that you won’t be interrupting any previously scheduled mealtimes or activities, it also gives the residents something to look forward to (and prepare for, if necessary.)
2. Be aware of what to expect. Some will have physical disabilities such as trouble with their hearing, eyesight, or ability to move freely. Some residents may have Alzheimer’s or dementia and may have trouble remembering people or conversations. If you aren’t sure how to respond in certain situations you can ask a member of the nursing staff for advice.
3. Knock before you enter a room. The residents’ rooms are their homes and should be treated as their personal and private space. It is polite to ask permission before entering a room or before handling personal objects on display, but residents will likely welcome queries or questions about photos or personal objects, and this is an excellent way to get a conversation started.
4. Be a good listener. Elderly residents have a lot of history and experience to share, and providing a friendly and attentive ear will be gratifying not only to your elderly friend or relative, but will likely be a fascinating experience for you as well.
5. Be aware of your host’s energy level. Nursing home residents can often tire quickly and 20-30 minutes may be a tiring visit for them. (On the other hand, if you and your host are in the middle of a conversation or game there is no need to rush through to stick to an arbitrary schedule.)
6. Bring photos, cards, or board games with you. Conversation will not always flow easily and freely, and having a back-up plan such as a deck of cards can dispel awkward silences. You may also consider offering to write or read letters for residents who may have trouble with these activities.
7. Don’t promise to visit again unless you truly intend to follow through and can even put it on your calendar right then and there. Nursing home residents may not get many visitors, breaking an appointment can be a heavy disappointment for your friend or relative.
A Mother’s Thoughts on the Struggle Between Adult Children and Their Aging Parents
November 28, 2011
Salon.com recently published a touching and illuminating article about Baby Boomers and their aging parents—about the transition from being the cared for child to the caregiving adult, and how Boomers are dealing with this new development. This is not the first article to be written on the subject, but this one is unique because it is written by one of the parents.
Author Lillian Rubin writes that she can see the growing worry in the eyes of her 63 year old daughter, “who wants me — her 87-year-old mother — to be in touch when I leave town, even if only for a few days or a week, who calls when she’s traveling though she never did before, whose anxiety announces itself over the phone lines when we haven’t talked for a while: ‘Are you OK?’ I tell her I’m fine, ask her to stop worrying. ‘It’s my turn to worry,’ she replies.”
Even when their parents still have the ability to care for themselves, Boomers can’t help but worry about what might be coming down the road, and when the shoe might drop. This worry can have the effect of putting adult children on edge, and making their parents feel smothered. Rubin writes movingly—and fairly—about the struggle on both sides of the divide. “Parents commonly resist their children’s attempts to intervene, but they are often in denial about the depth of their decline and can’t or won’t see what’s plain to others: They need help. If children back off from the conflict, their parents can fall through the cracks. If they don’t, parents are often resentful and difficult.”
Rubin admits that she has no easy answers, that every family will need to search for their own solution, but our firm knows that finding a solution is easier if you don’t have to do it alone. Having a solid estate plan is not going to solve all the problems between parents and their children, but having a good Advance Healthcare Directive and Financial Power of Attorney can certainly make both parent and child feel a little more secure. Furthermore, opening the lines of discussion for these two documents can clear the way for other important discussions down the road.
What To Do When You Discover That Mom or Dad Is Not Okay
November 21, 2011
In this day and age many families are spread across the country, with these winter holidays being their only chance to see each other during the year. This means that many adults are planning a trip this holiday season to visit aging parents they haven’t seen in months—or possibly haven’t seen in over a year! But what many people don’t anticipate is how much can change over a year, or even during a few short months. It is not unusual for adult children to find that their aging parents are not doing as well as they thought.
If a visit to your aging parents this holiday season brings up worries or concerns for you, or if you aren’t sure what to do or where to start, we have a few tips and suggestions that might help. Of course, every family will be different, but these suggestions can get you started down the road to ensuring your parents have the help and care they need.
1. First and foremost, talk to your parents.—some elderly people may be in denial about how much they need help, but many recognize when they begin losing the ability to care for themselves, and appreciate the opportunity to express their concerns and look for assistance.
2. Talk to your siblings—if you’ve noticed mom or dad aren’t doing so well, your siblings have probably noticed something too. Talking about the situation together may help you get a clearer picture of exactly what’s needed, and you may be able to plan the next steps together.
3. A recent article on the New York Times New Old Age Blog recommends contacting a geriatric care manager—this is someone who can work with you and your siblings together, someone “who can assess the situation, come up with a plan and supervise its execution.”
4. As also mentioned on the New Old Age Blog, sometimes the best thing to do is not to come in during the holidays and make snap decisions or sweeping changes, sometimes the best thing you can do is to make small, slow changes. The article points out that “engaging a bill-paying service or a chore service, a transportation program, a few hours a week of a home helper to handle laundry and shopping” can often make a huge difference.
5. Ask your parents if they have some kind of estate plan, or at the very least encourage them to have an advance healthcare directive or living will. If they do not have any kind of powers of attorney, try to help them find an estate planner or elder attorney they can trust and feel comfortable with, who can ensure they have the legal protections they need.
NOW is the Time to Think About Long-Term Care
November 11, 2011
As Baby Boomers begin to retire and to think about life after retirement, many find that one of their primary concerns is that of long-term care. Some news sources seem to think that paying for long-term care is going to be a number one issue in the coming years, not only for elderly individuals and their families, but for our society as a whole.
“The cost of long-term-care itself is not trivial. Nursing homes cost on average $87,235 annually… One year in an assisted-living facility is now $41,724. Adult day services are $70 per day, and home health aides cost $21 per hour… How can the country deliver and finance long-term-care for its rapidly aging population?”
It is comforting to know that AARP takes a somewhat less dramatic view of the issue. While they do agree that most seniors will at some point face the need for long-term care—“even if you’re in good health today, there’s a good chance that you’ll eventually need some type of long-term care, at least for awhile”— they urge people to take a pragmatic approach… and to start planning as early as possible. “The cost goes up with age, but it’s still affordable for many people over age 65. Once you hit the mid-70s, though, the cost of a good long-term care policy becomes very expensive, and it may be difficult to qualify for [it].”
An elder law or estate planning attorney is another resource for seniors and their families who are trying to plan ahead for the possibility of paying for long-term care. We specialize in helping you sort through your options, get your financial ducks in a row (right now and years down the line), and apply for government benefits, if necessary.
Don’t let the need for long-term care catch you by surprise. Contact our office to start planning now.
What Kind of Support Will You Have During Your Retirement?
November 9, 2011
Planning your retirement can seem fairly easy at first. As long as you’re careful to live within your means retirement can be a time of freedom, and the ability to explore interests you didn’t have time for before. But as this article in U.S. News and World Report reminds us, that freedom can eventually run out. “Most people retire when they are still healthy and can take care of themselves in their 60s, but you need to plan for a time when you might need more support.”
The article has some good suggestions about how older retirees can plan ahead to set up support systems when they need them. Some of the suggestions are time-honored solutions, such as living with family in a multi-generational household, but others are less obvious—although just as valuable.
One of these less obvious solutions is group living, or cohousing. “A cohousing building caters to community-minded residents who usually share many common rooms including a big communal kitchen, dining area, play room, and family room where residents can get together and socialize. This kind of community is much more close-knit and the neighbors will notice if you need help. . . Cohousing units generally have no staff and the residents take care of themselves and each other.”
Cohousing may be an ideal solution which offers freedom and support at the same time. But if you do decide that cohousing is the route you want to take, you may want to consult with your estate planner or elder law attorney ahead of time. Group living situations may require a buy-in or financial partnership and is not something to be entered into lightly. Any deeds or contracts should be reviewed by a legal professional before permanent steps are taken.
For more information about senior living options please contact our office. We are here to help.
Senior Citizens to Receive a Raise
October 21, 2011
There is good news today for senior citizens! According to this article in CNN Money, “Social Security recipients will receive a cost of living adjustment of 3.6% starting in January.” This will be the first “raise” recipients have seen in three years, and most welcome the increase. “Many seniors have felt squeezed since banks are paying virtually no interest on savings accounts and stock market declines has eroded their retirement accounts.”
Unfortunately, many seniors may not see a useful increase in their social security income thanks to a hike in Medicare premiums expected to be announced next month. “For the past two years when Social Security benefits stayed the same, many seniors were shielded from the increase in Medicare premiums because of a “hold harmless” provision that protects more than 70% of beneficiaries… However, high-income beneficiaries and new enrollees did see their benefits reduced because they are not covered under the provision.”
Even with the expected increase to Medicare premiums, most seniors are simply glad to see evidence that The-Powers-That-Be recognize the rising cost of living. While most recipients of Social Security do have an alternate form of income, with their SS benefits representing “about 41% of the elderly’s income”; there are some who “rely on the monthly checks for 90% of their income.”
For more complete information about the coming changes in Social Security please read the full article. For help understanding how this change may fit in with your other benefits, or may affect your estate planning, please contact our office.