Articles Posted in Elder Law

One of the most confusing aspects of the Medicaid program is the look back period for asset transfers and how it can affect the eligibility for applicants to the program. The Medicaid program is different than the Medicare program, although people often think of the two terms as interchangeable. Medicare is an entitlement program paid for through withholdings in paychecks. Medicaid is a social welfare program designed for people who need medical care and cannot afford it. Medicaid is administered by each state, which means that the rules and benefits can vary from place to place.

Medicaid Qualification

The Medicaid program goes into effect once a person no longer has the money to pay for medical care on their own. This means that as long as you have assets that you can sell you are not eligible for the Medicaid program. Long-term planning can protect some portion of savings and assets for a spouse or children while still allowing you to qualify for Medicaid coverage. One way to keep assets and still qualify is to transfer assets to family before applying to the Medicaid program, but you must beware of the Medicaid look back period.

Over 1.4 million seniors are currently living in a nursing home in the United States. While most dislike or fear nursing homes, it is usually the best option for a senior that needs 24-hour care. Nursing homes typically have a reputation for being smelly, unfriendly, and indifferent places where the elderly is left to spend their final years until they die. However, there are plenty of nursing home facilities that can be even better than home care, and good facilities outnumber the bad when it comes to nursing home and long-term care.

Preparing to Choose a Nursing Home

One of the biggest mistakes that can be made when choosing a nursing home facility is waiting until the last minute. Especially when faced with a medical or financial crisis, being forced into an impulsive decision is never the best option. When choosing a nursing home you need to do the research, start looking around, see what services are available, and figure out what will be best for your loved one.

This summer, one nursing home settled a massive class action suit against the facility for using powerful and dangerous drugs on its residents without their informed consent or consent from family members. One member of the suit was a daughter whose mother entered the facility for eighteen days for physical therapy for a broken pelvis. The nursing home had given her heavy medication, including many dangerous antipsychotics, and within a matter of weeks she was dead. This class action lawsuit was the first of its kind in the country, and with a growing issue of drug abuse in nursing homes it will most likely not be the last.

A Growing National Issue

Sadly, this case is not an isolated event. Researchers estimate that as many as one in five elderly patients in nursing homes are given powerful antipsychotics and other drugs that are wholly unnecessary. This growing trend comes from a variety of sources, including but not limited to inadequate training of staff, understaffing of facilities, and aggressive selling by pharmaceutical companies. The Center for Medicare Advocacy has been quoted as saying that “The misuse of antipsychotic drugs as chemical restraints is one of the most common and long-standing, but preventable, practices causing serious harm to nursing home residents today.”

The Massachusetts Senate just passed through a bill adopting the model set of rules for the Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act (UAGPPJA). The bill now goes to the state House of Representatives, and if it is passed then Massachusetts will be the thirty-ninth state in the country to adopt this act. This model set of rules makes it easier for family caregivers to provide care for their loved ones across state lines.

Guardianship

A court will appoint a guardian to a person when someone is incapable of managing personal decisions or property. The guardian then makes decisions about personal property, medical choices, living arrangements, and financial issues. Appointing a guardian in court can be difficult and time consuming; however, they are a great way to prevent elder abuse, neglect, or exploitation.

One of the most important parts of elder care is ensuring that you or your loved one is financially secure in later years. A wide variety of financial tools and plans are available to help structure this care for seniors, but as of July a new tool has been introduced for retirement planning that has not been widely available before – longevity insurance.

What is Longevity Insurance?

Longevity insurance is also known as a deferred-income annuity. You pay a lump sum of money as a premium to an insurer in exchange for a lifelong stream of income that begins years later, even as late as your 70s or 80s. Before July, longevity insurance could not be widely used in 401(k) or other individual retirement plans because those types of plans require that the holder start making withdrawals at age 70½. The rules have now been changed that allow workers to purchase these annuities if they use a portion of their retirement money and begin to make withdrawals by age 85.

Some of the leaders in providing shelters for victims of elder abuse are meeting for the first time at a conference in an effort to combine forces and give more refuge to seniors in need. Eight shelters have formed an alliance that are meeting in suburban Cincinnati to discuss the growing problem of elder abuse as well as ways to better combat the issue. The shelters in the alliance have been participating in monthly conference calls to discuss their programs, and this is the first time that they will all be meeting in person to talk about their elder abuse shelters. They plan on sharing best practices, are bringing in expert guest speakers, and work together to create an even better network of elder abuse shelters.

Elder Abuse and Prevention

Estimates from leading researchers are that at least two million seniors are abused, exploited, and neglected every year in the United States alone. In addition, nearly everyone agrees that many more cases of elder abuse go unreported or undetected. The number of seniors over the age of seventy is expected to more than double to about 64 million people by 2050. Elder abuse occurs most often at the hands of a family member or other people close to the victim.

Casey Kasem was known mostly for his long and illustrious career in radio. Almost everyone remembers his years on “American Top 40” or hearing him as the voice of Shaggy in the cartoon, Scooby Doo. However, his final years on earth also left his fans with a cautionary tale about caregiving and the problems that can arise.

During the last couple of years of his life, Casey Kasem’s family was torn about his caregiving needs. On one side were his children from his first marriage, and on the other side was his second wife. Their bickering led to very public court battles, and it culminated in his wife moving Kasem without telling his children of his location. In the end, one of his children was appointed his custodian, and thankfully his entire family was able to see him before he passed.

Family Conflict and Caregiving

The World Health Organization estimates that by 2050, the number of people who live past their 80th birthday will be roughly 395 million, more than quadruple the current number. Additionally, the Alzheimer’s Society has found that over 80% of residents in nursing homes and assisted living care now have dementia or some type of serious memory problems. These types of issues demand constant care and considerable cost. With an increasing number of seniors worldwide and the skyrocketing costs, younger generations are looking for new options in elder care. A growing trend in elder care is to send seniors to living care facilities abroad in countries such as Thailand, where the costs of care are lower and the care is more comprehensive.

Benefits of Elder Care Abroad

The biggest reason that people are looking at elder care abroad is cost. In the United States, live-in care can cost anywhere from $3,000 to $6,000 per month. Assisted living or nursing home care can be even more expensive. In other countries, elder care costs are just as high. In the United Kingdom, cost ranges from US $3,600 to $5,000 per month, and in Switzerland elder care costs run monthly on average from US $5,000 to $10,000. However, in places like Thailand the cost of elder care runs at maximum around $3,000 per month and the level of care are much more comprehensive. At that price three or four caretakers look after a single patient, and 24-hour care is very feasible.

In a ruling Monday, Judge Daniel S. Murphy ordered that renowned radio personality Casey Kasem must be fed, hydrated, and medicated at the discretion of his doctors. This order is the latest in a string of court battles between Kasem’s wife and children about his medical care. Casey Kasem suffers from a form of dementia similar to Parkinson’s and is no longer able to communicate with his family. Last month his wife, Jean, moved him from his care facility in Santa Monica to a friend’s home in the state of Washington without disclosing his whereabouts to his children, and after the incident Kasem’s daughter, Kerri, was named as his temporary conservator. This latest order comes from Kerri’s request that doctors begin end-of-life procedures for her father. Kasem’s wife vehemently opposed the request and argued that she feels like he would want to live as long as possible.

All of these arguments could have been avoided if Casey Kasem had filled out an advance directive that gave clear directions for his final wishes about his medical care.

What is an Advance Directive?

Choosing to move into a continuing care retirement facility (CCRF) is one of the biggest decisions you can make in your later years. A lot of factors go into getting financial matters in place and ensuring that a particular facility is right for you. However, there are some resources and tips that can make the process of choosing a continuing care facility a little more manageable.

Resources for Finding a Reputable CCRF

According to the National Investment Center for Seniors Housing & Care Industry in the United States there are over 2,000 continuing care facilities with more than 600,000 residents. CCRFs can be nonprofit or for-profit entities. For a list of nonprofit care facilities, you can research your options at Leading Age, and for a list of all facilities including those for-profit you can research communities (for a $24.95 fee) at the Retirement Living Information Center.