Long Term Care Planning

Another Study Emphasizes the High Costs of Long-Term Care

Published on: January 24, 2012 | by Ettinger Law Firm

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Yet another company, Northwestern Mutual, has recently issued a “Cost of Long-Term Care” study. Of course, the results indicate that the actual cost depends on a range of factors including what part of the country one lives, whether an at-home aide is hired, or whether one moves into a skilled nursing facility. As any New York elder law attorney can attest, our area is always at the very top of the list when it comes to long-term care costs. It is for that reason that it is particularly incumbent upon area resident to meet with an elder law attorney to plan ahead before the costs actually need to be paid. It is simply impossible for most families to bear the financial burden of this care on their own.

This latest research effort from Northwestern Mutual involved surveys from 6,000 different sources, including a mix of assisted living facilities, home health care organizations, and nursing homes. The researchers found that the hourly rate for home healthcare workers was anywhere from $33 per hour to $15 per hour. New York assistance was near the highest of the group.

Elder Caregivers Found To Have Higher Levels of Stress & Health Issues

Published on: January 20, 2012 | by Ettinger Law Firm

The focus of most New York elder care planning discussions naturally revolves around the needs of seniors. Are they receiving proper nutrition? Do their caregivers timely attend to their dressing, bathing, and washroom needs? Do they remain connected to the community with opportunities to use their unique skills and abilities? Our New York elder law attorneys know that for far too many seniors, even these basic needs remain unmet. The problem of elder neglect and abuse is troubling, and it will likely become more of a concern in the coming years as the population ages and the total number of seniors in need of extra help skyrockets.

However, a holistic approach to senior care requires not just consideration of the senior’s needs but also understanding of the effects on senior caregivers. A CNN Living article this week examined the way that helping an elder resident impacts adult family members. The story of one woman was shared who took her 72-year old father out of a nursing home out of concerns for his well-being. Instead she moved him into her on own two bedroom apartment. The woman admits that she put her life on hold, because the obligations of working full-time while helping her father was overwhelming. She was often required to miss work to take him to a wide range of appointments with medical professionals. In addition, she used her lunch breaks to ensure he took his medications and made it to his dialysis appointments. She confesses, “It was like ‘oh my, what did I get myself into?’ Sometimes I would just go into the bathroom and cry.”

Her situation is not unique as a new “Stress in America” survey from the American Psychological Association found that at least 55% of senior caregivers feel overwhelmed by the task. Not only did the caregivers report higher levels of personal stress, but they were also found to be in poorer health themselves. Caregivers were more likely to engage in unhealthy behaviors in an attempt to alleviate the stress.

Happiest Nursing Home Staff Members Work at Nonprofit Facilities

Published on: January 5, 2012 | by Ettinger Law Firm

Making the decision to place a loved one in a nursing home is no routine matter. Emotions run deep during this time, when families struggle to balance the senior’s need for close care and safety with their concerns about the quality of life available in these assisted-living facilities. Our New York elder law estate planning attorneys have helped many families with this process. We appreciate that there are usually two big questions that come up: (1) What is the best facility for our loved one? and (2) How are we going to pay for it?

In answering the latter question, New York elder law attorneys will explain that the costs can either be paid out of pocket, via use of private long-term care insurance, or through the New York Medicaid system. The former question is a bit more challenging, because so much subjectivity is involved. The answer for each family is different. The exact type of care needed, proximity to loved ones, and similar details need to be considered when choosing which nursing home is best. Of course, as a general matter, every family will want to ensure that the nursing home they chose is one free of chronic neglect, mistreatment, and abuse. Many elder care advocates have explained that when it comes to safety measures, study after study has found that nonprofit nursing homes outperform for-profit facilities. One long-term care doctor explained, “Most studies show that nonprofits do a better job of caring for patients, but we’re not sure why that happens.” This is an important consideration for families deciding where to send their loved one.

A post this week in the New Old Age blog from the New York Times recently discussed another interesting comparison between for-profit and nonprofit homes: the employees are happiest at nonprofit nursing homes. This may be part of the reason why care at these facilities is superior. At the end of the day, the quality of life for those in these facilities is dependent on the work performed by the hands-on caregivers. Therefore, how those caregivers perceive their job is likely to play a key role in their day-to-day actions. The nonprofit employees were happier overall for a variety of reasons: their ability to help set policy, more supportive managers, and availability of adequate resources.

Advocates Call for More GLBT Friendly Senior Housing Options

Published on: January 3, 2012 | by Ettinger Law Firm

Many writers have taken to calling the upcoming wave of baby boomer retirements as the “silver tsunami.” Like real tsunamis, the demographic shift is expected to have many ripple effects in communities across the country. Each New York elder law attorney at our firm has seen first-hand the challenges faced by many in our area when trying to figure out where they will receive long-term senior care and how they will pay for it. These issues are common to all local families who have loved ones about to leave the work force to enjoy time in their golden years.

However, some senior community members have even more unique concerns.

The Associated Press published an interesting article this week discussing the struggles of senior GLBT community members. Public opinion data consistently shows that the younger generation is much more open and supportive of their gay, lesbian, bisexual, and transgendered community members. Older Americans are less approving. That is leading many gay seniors to wonder how they might be treated if they end up in a traditional nursing home or long-term care facility. One expert summarized that many of these “seniors fear discrimination, disrespect or worse by health care workers and residents of elder housing facilities, ultimately leading many back into the closet after years of being open.” In addition, GLBT seniors are much less likely to have biological family members to help them through this time of their life. Estrangement and childlessness are more common for gay seniors, making them more dependent on outside services.

Home Care Workers and the Minimum Wage Controversy

Published on: December 22, 2011 | by Ettinger Law Firm

Local seniors obtain peace of mind knowing that they will be able to receive late-in-life care in an ideal setting and that the care will be of top quality. These simple goals should not be out of reach for any elder community member. However each New York elder law attorney at our firm knows that many seniors will be forced to deal with less than adequate care, often in institutional settings where they would rather not live.

Part of the problem is that many local residents will not have visited with a New York elder law professional ahead of time to plan for this time in life. Staying in one’s home while aging usually requires advance planning. However, it is not enough to merely have the aid of a home care worker–one must ensure that the worker is actually providing an appropriate level of care. A recent article from Aging Parents explained that there has been a shortage of quality home care workers. One of the problems, argues the author, is the fact that for a period these workers were exempt from minimum wage laws. When Congress passed minimum rights legislation, all home care workers were lumped into the category of exempt employees who acted as “companions.” This was the case even for workers who engaged in a wide range of physical labor helping seniors bathe, dress, use the facilities, walk, get exercise, and eat properly. Of course, it seems intuitively unfair for these workers to be forced to live in dire poverty at incredibly low wages and no overtime pay.

Fortunately, the legal error was recently corrected. The author suggests that part of the reason the law took so long to change was that many of the individuals who fill these roles have few advocates, often including women and those who are not native English speakers. Also, as a result of the prolonged period of abysmal pay, advocates are worried that there is a shortage of well-trained, capable home health care workers. The need for these workers is expected to skyrocket in the coming decades.

Fiftieth Anniversary Celebration For U.S. Senate Special Committee on Aging

Published on: December 20, 2011 | by Ettinger Law Firm

Each New York elder law attorney at our firm understands that maximizing the quality of life for local seniors requires both proper individual planning and common sense elder law policy proposals at the local, state, and federal levels. On the planning side, all local residents should visit with a New York elder care lawyer to prepare for disability, save taxes from Medicaid costs, and deal with similar issues. When it comes to policy, it is helpful to stay up to date with changes that are being proposed which may affect the lives of seniors. One of the key governmental bodies related to these issues is the U.S. Special Committee on Aging. This Senate committee has been at the center of all important federal elder law issues over the past half century.

Last week the National Academy of Elder Law Attorneys (NAELA) issued a special proclamation honoring the 50th Anniversary of the U.S. Special Committee on Aging. NAELA, a nationwide group of elder law attorneys, also co-sponsored an event in Washington D.C. honoring the committee’s achievements.

The Special Committee was first created in 1961 as a central national clearinghouse to discuss and deliberate on a wide range of issues that affect senior citizens. Over the years the committee has been involved in any number of senior issues, from health care problems and elder financial exploitation to retirement security and nursing home abuse. In recent years the Special Committee on Aging has led the way in passage of the Elder Justice Act, Older Americans Act, and a wide range of issues seeking to improve the care at long-term skilled nursing facilities. Last year the committee brought national attention to senior housing issues during its hearing entitled “Continuing Care, Retirement Communities: Secure Retirement or Risky Investment?” In recent years the Committee served as the center of other important debates such as during the hearings “Exploitation of Seniors: America’s Ailing Guardianship System” and “Sound Policy, Smart Solutions: Saving Money in Medicaid.”

AARP Release new “Aging in Place” Survey

Published on: December 16, 2011 | by Ettinger Law Firm

This month the AARP’s Public Policy Institute, in conjunction with the National Conference of State Legislatures, released a new report that is of direct applicability to all those concerned about their New York long-term care plans. Entitled, “Aging in Place: A State Survey of Livability Policies and Practices,” the project is focused entirely on analyzing what states are doing (or not doing) to help seniors stay in their own homes as they age. As the report authors note, the vast majority of seniors prefer to age in place, but their ability to do so is in many ways dependent on how communities are designed and senior care programs implemented. Toward that end, the report took a look at land use policies, transportation services, and housing options across to country which are helping seniors meet their goal of avoiding the need to move.

When it comes to land use, the report found it crucial to integrate necessary services with transportation planning to reduce automobile travel. If older adults can more easily walk or otherwise reach necessary support services, they will be able to live in place longer. Also found to be helpful were requirements for implementing transit-oriented development within a half mile of transit stops and joint use of community facilities for senior centers and health clinics. Similarly, increased public transportation options are important to the efforts of many seniors to stay in place. “Complete street” policies are in place in some states requiring designs which allow travelers of all ages and abilities to navigate the street. The policy institute also suggested better coordination between human service transportation agencies. The coordination allows these agencies to do more with fewer resources.

When it comes to housing, many elder care plans are created specifically to help seniors have access to preferable living situations–usually outside of the nursing home. However, the AARP report found that there is a shortfall in affordable and accessible housing for seniors, making it difficult to avoid the institutional setting. To help, the authors suggested states make use of the federal Low-Income Housing Tax Credit programs to obtain more funds to increase the affordable housing supply. Similarly, developers should be encouraged to increase accessibility by altering building standards.

Critics Share Concerns About Federal Proposals Amid Retirement Security Crisis

Published on: December 14, 2011 | by Ettinger Law Firm

The Nieman Watchdog–Harvard’s journalism faculty blog–recently published a commentary speaking to the looming “retirement crisis” and the problems with the federal government’s current approach to dealing with it. The author notes that retirement planning is not what it used to be as many workers today are “facing a grim future in which the kind of retirement plans their parents were able to take for granted is out of reach.” Our New York elder law attorneys have discussed these changing dynamics and the demand they place on thinking about long-term care plans in new ways.

The commentary notes that it is folly to presume that one will be taken care of in the future, because the growth of “defined contribution plans” (as opposed to “defined benefits plans”) means that retirement savings often hinge on the performance of the markets. It is argued that this shift has made income from private pensions smaller and less reliable than in the past. That issue, coupled with rising health care costs, places a real strain on many retirement plans.

Considering those concerns, it is perhaps surprising that federal policymakers have spent most of their time discussing cuts to Social Security, Medicare, and Medicaid. The problem also exists at the state level, as New York Medicaid planners have been forced to watch as state policymakers consider a wide range of proposals to revamp the healthcare system that so many local seniors rely on for long-term care support.

AARP Report Finds Expanding Costs of Family Elder Caregiving

Published on: November 15, 2011 | by Ettinger Law Firm

The AARP Public Policy Institute recently released a new report discussing the contributions that family members nationwide make to caring for their elderly family members. Recent news has focused on how local, state, and federal governments will handle the burdens of caring for an aging population. Yet, as this new report points out, the costs bore by family caregivers actually dwarfs that spent by these public bodies. It is a reminder that long-term care planning remains more than just a necessity for seniors but also for their entire family.

The size of the numbers is undeniable. Roughly 42 million family members are acting as caregivers for their senior loved ones at any point in time, with nearly 62 million providing at least some support throughout the year. In economic terms, these caregivers provide over $450 billion in annual, unpaid care. That total is up 20% from two years before ($375 billion). These totals include the contributions of millions of area residents who provide support for aging family members whose New York elder care planning went awry or whose plan was nonexistent. The financial estimates are actually conservative. They do not account for care given by those under the age of 18. They also do not include caregivers who provide assistance outside of basic daily living tasks, like help with bathing, dressing, managing medications, and aid with finances.

It is helpful to put these family-provided long-term elder care costs into context. The $450 billion annual sum is more than the total Medicaid spending, for both basic health and long-term support services. When looking only at Medicaid support for senior care, the costs bore by families is four times larger. Researchers believe that the $75 billion increase in the previous two years was primarily caused by an increase in the total number of caregivers and hours of care provided. In other words, the allotted value of the work ($11.16 per hour) remained constant over that period of time.

Congressman Shares Information About Federal Attempt to Solve Long-Term Care Crisis

Published on: November 4, 2011 | by Ettinger Law Firm

On Wednesday Congressman Ted Deutch published an editorial in Politico advocating on behalf of a stalled federal initiative known as the Community Living Assistance Services and Supports Act (CLASS). The measure was hailed as the first federal attempt to address the nation’s long-term care crisis. All those in our area who have dealt with the complexities and expense of finding proper New York elder care are likely familiar with this crisis. CLASS was part of the high-profile Affordable Care Act that passed Congress, but CLASS was recently suspended by the President.

The Representative explained that CLASS was essentially a means by which middle class families could have a voluntary and affordable long-term care insurance option. An important part of the CLASS program that needed to be addressed was the idea of “adverse selection”–the notion that insurance would only be bought by those who already needed the care. Of course, the maximum benefit is derived only when individuals have this insurance plan in place ahead of time. The measure is currently stalled specifically because of concerns about adverse selection. Yet, many, including Representative Deutch, believe that federal officials have statutory power to implement anti-adverse-selection measures.

CLASS was pushed by those who understand the looming problem facing the long-term care system. Only five percent of Americans have long-term care insurance, even though seventy to seventy five percent of all Americans will need some form of long-term care. The gap is often replaced by federal programs, like Medicaid. The Congressman explained that the reliance on Medicaid is unsustainable at the federal level. This is in addition to the fact that qualifying for Medicaid often requires residents to spend themselves into poverty, especially when planning is absent. Fixing the problem before it gets worse was the motivation behind CLASS. The measure hopes to steer residents away from the most expensive institutionalized care to more balanced programs that encourage cost-effective and resident-focused community care. Besides the cost savings, these programs are almost always preferred by seniors, because they allow them to live at home, maximizing their freedom.