Articles Posted in Long Term Care Planning

Our NY estate planning lawyers frequently advise local residents that in virtually all cases the single best way to prepare for possible senior care needs is by purchasing long-term care insurance (LTCI). Unfortunately, the biggest barrier for most families in securing LTCI is cost. Depending on one’s age when purchasing the product, the premiums can be prohibitive. Gender also plays a role, as women may have higher rates because of their longer life expectancy. We reported last month on one large LTCI insurer, Genworth, making the decision to institute “differential pricing” to charge women more. Reports suggest there could anywhere from a 25% to 40% gender price gap.

Of course the trajectory of these insurance costs mirror the actual costs for nursing home stays or at-home caregivers. As the price of that care rises, so does the cost of LTCI insurance.

Act Now and Act Smart

It is no secret that most New Yorkers would prefer to “age in place” instead of moving into a nursing home. For one thing, having access to the comforts of one’s own home and the freedom to live as independently as possible is a natural goal. On top of that, however, are the myriad of horror stories that continue to pop up regarding mistreatment, neglect, and outright abuse that is sometime perpetrated at skilled nursing facilities. If you read enough of those harrowing accounts, it is easy to get the impression that these homes are no place to thrive in your golden years.

A new story coming out of Queens offers little relief. As reported this weekend in the NY Daily News, a former director of nursing at a Queens facility is now facing criminal charges for her conduct following a resident’s wandering from the facility.

Authorities explain how two weeks ago a 74-year old resident of the facility went missing. He was apparently not properly supervised and wandered out of the home without notice of the caregivers. The man has dementia, and obviously is at risk of serious harm while alone in the community. The senior has still not been found.

The reverberations of Hurricane Sandy’s impact on the city are far from finished. We will be cleaning up and adapting for many months–likely years–into the future. Considering the predictions of some, we may even have to deal with large storms of this magnitude on a far more consistent basis. It affects all areas of life–including things like senior care and nursing home operations.

Many New Yorkers were shocked to learn of the goings-on at some long-term care facilities hit hardest by Sandy. Stories have been told of seniors stuck in upper levels of flooded facilities for days without power. Many questions have been raised about the management of the long-term care facilities and confusion over why the senior residents were not evacuated. In fact, in large part because of the struggle with NYC nursing home evacuations during Sandy, the Center for Medicare and Medicaid Services (CMS) will release new disaster planning for all nursing homes in the coming year.

Looking to the future, local residents are advised to understand evacuation plans for long-term care facilities where loved ones reside–or to ask about such plans when making nursing home choices. An AARP story recently profiled nursing home evacuation plans, pointing out the critical issues that facility caregivers need to consider. It is worth browsing the list to get an idea of the questions that owners and operators in New York need to be asked to ensure that seniors are protected in case any manner of natural or man-made disaster strikes requiring quick action.

From suspicious claims in an email to unsolicited letters, most of us assume we are not naive enough to fall victim to a financial scammer. This is a mistake. It takes only a moment of confusion or a lapse in judgement to provide a fraudster with the the tools they need to steal.

Financial scammers thrive in confusion and unfamiliarity. There is a reason that seniors are targeting more often than others–the elderly may be less familiar with certain aspects of modern technology or culture. As such, scammers are able to poke at their uncertainty in order to gain trust and ultimately take advantage.

These frauds are often connected to current events. Disgustingly, it was only hours after the Boston bombings that some fake charities were set up in an attempt to dupe well-intentioned community members into donating money that would end up in the pockets of criminals. Along the same lines, fraudsters are trying to exploit unfamiliarity and confusion about the high-profile national health care law. Many aspects of the law are set to take effect this year, and most community members are unfamiliar with the details of those changes. Scam artists are stepping into the void, working to use the complexity of the law to solicit funds from unsuspecting community members. Senior citizens are the most likely to be hurt.

If stereotypes are to be believed, all living arrangements outside of the home are mired in neglect, confusion, and unhappiness. Virtually no one claims that they want to move into a nursing home or assisted living facility, and many assume that leaving one’s house is only done at the last possible minute and often under duress.

This sort of generalizing about the “horrors” of senior care facilities is often misplaced. There are certainly many low-quality homes and individual residents who despise their living situation. But that is not at all to say that every facility–or even a majority–are like that. The truth is that there are many homes that allow residents to thrive, providing support so that their daily lives are more fulfilled than before, when they lived in their own home (often alone) and without necessary assistance with day to day tasks.

On that topic, a recent New York Times “New Old Age” blog post provides some interesting first-person discussion with one of the nation’s “foremost advocate for people living in assisted living,” Martin Bayne.

This week the New York Times published a story that will likely ring true to all those who have gone through the process of helping a loved one figure out how to secure the ideal long-term care. It is one of those issues that is easy to talk about in the abstract but that comes packed with intense emotion when one is actually thrust into it and forced to help those closest to them.

One of the scariest aspects to this situation is that it can arise virtually overnight. The NYT story shares the example of one man whose 81-year old parents seemed to go from swimming and playing sports to both becoming frail the next day. Their ailments struck at the same time. His mother developed dementia and passed away within a year of first falling ill. This left the family in a very tough spot. In the midst of grief, they had to make tough choices about how to ensure their father had proper care. Fortunately, the family was in a much better position than many, because the patriarch had purchased a long-term care insurance policy nearly three decades before. That insurance has been able to provide at-home caregivers for the last two years.

That is a key reason why the NY elder law attorneys at our firm encourage families to use long-term care insurance when possible while crafting long-term care plans.

Sunshine is often the best medicine–particularly when it comes to worries about quality of care and value of public services. When community members are able to easily find out information which explains how much services cost, error rates, and similar details, then efficiency and overall quality will likely improve. That is the idea behind a new “Sunshine Week” project that is being unrolled this week by state officials. As discussed in Business Journal story, the initiative is spearheaded by Governor Cuomo’s office in order to raise awareness of the value of open government.

The project is actually a series of unveilings, all focused on providing data in easily understood formats for residents. Conveniently, the data is all available of a new website: The New York Open Data Portal.

The goal is comprehensive, intending to provide a single location for community members to obtain information about virtually every area of government services, from county-based crime statistics to recommended fishing and river locations. Some aspects of the project may be valuable to area senior citizens and their families. For example, you can view a spreadsheet that lists the specific expenditures from the Office of Aging based on fiscal year and county.

Many of the changes and new rules associated with health insurance as part of the “Affordable Care Act” (Obamacare) will only take effect over the next year or two. One of those new rules prohibits most health insurance providers from making premium pricing decisions based on one’s gender. However, those rules do not apply to companies that provide long-term care insurance.

Therefore it does not come as a huge surprise that the nation’s largest provider of such insurance–Genworth Financial–announced that they will soon being change rate plans to account for the fact that women are more likely to need paid long-term care. According to a Washington Post story, women seeking such insurance on their own will likely see anywhere from a twenty to forty percent increases in yearly long-term care insurance payments. Importantly, the change will only affect new policyholders, as current members should not be affected. Observers note that other long-term care insurance providers will likely follow suit.

The policy change was made, say the company, because of the fact that over ⅔ of all claims on the insurance are made by women. In order to stabilize prices, the company claims that the premium rates needed to better reflect the risk and ultimate need for long-term care. The increased claims by women are likely a product of the fact that they generally live longer and provide care to their own spouses. Men are far likelier to avoid having to make claims on the insurance because their health declines sooner and their spouse often provides care. Elderly women, however, often come to need support after their spouse has passed, and they do not have the luxury of receiving free care from a relative.

Last year federal legislation was passed affecting elder care issues. In particular, the new law eliminated a floundering attempt to create a national long-term care insurance program. At the same time, the law also called for the creation of a commission to study issues of senior care financing, delivery, and workforce needs. Known as the “Long-Term Care Commission,” the general idea was that the diverse Commission would investigate the issues, create policy proposals, and submit the ideas to Congress to spur possible legislation.

The Status Update

Unfortunately, as a recent Forbes story shares, the Commission is still in dock and there are serious doubts as to whether it will be able to achieve its mission at all. The first issue is that the slate of 15 people to sit on the panel have yet to be decided upon. Apparently the White House has yet to make its three choices, and nothing can be done until the roster is actually complete.

The challenges of securing appropriate long-term care are often only understood at the exact moment when that care is needed. After a sudden medical emergency, accident, or other change in condition, many families discover that an elder loved one is in need of long-term help to get by each day. These families then face two difficult questIons: (1) How are we going to pay for it?; (2) How do we know that the quality of the caregivers is sufficient?

For one thing, the financing of long-term care can be secured in many different ways. A NY elder law attorney can explain what options are available in your specific case. Those options may involve insurance, the use of Medicaid Asset Protection trusts, or other unique strategies to save funds even when on the nursing home doorstep. There is no getting around the fact that elder care is quite expensive–startling so–but planning ahead with professionals can save significant sums.

But paying for care is only part of the battle. It is also critical that family members ensure their love ones actually receive the care they deserve, no matter what facility they enter. Sadly, without proper oversight, seniors may face severe neglect or outright abuse by those charged with their well being.

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