Articles Posted in NY Elder Law

Deciding how to receive the medical care that a person needs is a critical part of the elder law process. Unfortunately, the unpredictable nature of aging and medical issues can make it challenging to determine what lies ahead. Various states have also begun to attempt to resolve financing challenges associated with elder care that a growing number of Americans will face in the next couple of decades as a growing portion of the baby boomer generation requires medical care.

The Growing Need for Assistance

Any person can end up needing assistance as they age. This is true regardless of whether a person ends up facing dementia, a significant drop in eyesight, or mobility issues. The degree of assistance and how long a person faces these issues can vary substantially. A person might end up needing assistance with meals, other daily living activities, or total care for the months or years before they pass away. Other times, people end up needing total care for years. The unpredictable nature of a person’s future makes it challenging to plan ahead.

The combined pressures of growing need, rising costs, and altered ideas of the best way to live one’s golden years is leading to a revolution in the look and feel of elder care. To be sure, changes in the way seniors in need receive support are still occurring far too slow for some advocates. But it is undeniable that many seniors now are cared for differently than their parents and the trend will only continue in the coming years and decades.

One common suggestion is that communal living spaces (like nursing homes) are closing and being replaced by a growth in at-home caregivers. While that change is occurring, it oversimplifies the new landscape of seniors care. There are different version of at-home support and even communal living.

Senior Villages

A somewhat bizarre story out of Europe is leading a few elder care experts in the United States to question whether “shipping away” seniors may be part of the future of long-term care for some families.

As reported by the BBC, one adult daughter in Switzerland ignited an ethical debate recently by deciding to send her mother to a long-term care home in Thailand for support. The daughter explained that her decision was based on both her mother’s specific condition and financial realities. The 91-year old mother apparently suffers from severe dementia, and is unable to remember much of anything about the present. In addition, the cost of care in Switzerland was incredibly high–similar to that in New York–while Thai care was far more affordable. The daughter felt that her mother could receive better services in Thailand where she now lives with a group of other Swiss and German seniors.

A Wave of the Future?

The changing face of New York nursing home care continued this weekend as another county officially got out of the elder care business. As reported by Syracuse News, the Van Duyn Home and Hospital was transferred by Onondaga County to the “Upstate Services Group” — a private company that owns at least eleven other New York elder care facilities.

This transition was in the works for quite some. The news report explains how the facility has long-been plagued by accusations of poor care on top of acting as a huge financial burden for the county itself. In fact, Van Duyn was under intense scrutiny from federal regulators for its poor caregiving track record. That is on top of more than a dozen private civil lawsuits filed by former residents and their family members against the county alleging negligence.

The financial issue combined with care quality concerns led many to suspect that the 500-bed facility would be shuttered. However, with this transition to private ownership, it appears the the facility is safe–at least for now. Interestingly, one of the main concerns with sales of public facilities to private companies is the risk of a decrease in quality for residents. However, in this case, because of Van Duyn’s poor track record in the past, there were less complaints of that nature.

Many of us can relate to growing concerns over loved ones as they continue to age and require more assistance. It can be challenging to meet these changing needs while still recognizing that our elderly loved ones are capable of performing some tasks on their own. It may seem obvious that legal remedies exist for those addressing extreme issues brought up by dementia and other forms of degenerative disease in elderly family members, who may entirely depend on a third party for assistance with daily life activities. What may not be as obvious is that those solutions are legally available to help address our elderly loved one’s needs without necessarily having them declared incompetent, while also enabling them to utilize a proper degree of autonomy.

New York Law

New York Mental Hygiene Law Article 81 was enacted to provide those seeking guardianship, and the Courts, the opportunity of using the least restrictive means of intervention in order to meet the specific personal or property management needs of the elderly individual while still maintaining an appropriate level of independence based on their capabilities. Specifically, Section 81.02(a)(2) of the Article provides that the Court may appoint a guardian to provide for the personal or financial needs of a person without having them declared incompetent, so long as that person agrees to the appointment. This becomes especially relevant in those situations where an individual is just starting to exhibit the first signs or symptoms of a degenerative disease affecting their mental capacity.

You may remember that on New Year’s Day of this year, a large piece of legislation was passed by Congress and signed by President Obama. The bill was the one that (temporarily) avoided the fiscal cliff. It was the measure that seemed to permanently set the estate tax rates among other things.

At the same time, the legislation also called for the creation of a Long-Term Care Commission. Comprised of 15 members, selected by both Republican and Democratic leaders, the group was given six months to hold hearings, debate, discuss, and create a report on various issues regarding long-term care nationwide. More specifically, the entity’s specific charge was to “develop recommendations for the establishment, implementation, and financing of a comprehensive, coordinated, and high-quality system that ensures the availability of long-term services and supports for individuals who depend on this system to live full and healthy lives.”

The Recommendations

Advocating for better long-term care is not just a concern of NY elder law attorneys. Policymakers at all levels and of all political persuasions are also keenly aware of the impact that the growing need for long-term care will have on communities nationwide.

There are few challenges more acute than figuring out how to ensure adequate senior care for all community members. As most know, we are on the cusp of a “gray wave” with demographics changes requiring an increased commitment to skilled care and assistance for seniors. The need extends to all facets of elder care, from ensuring there are enough physical spaces for those in need to coming up with ways to pay for the care.

Federal LTC Commission

Elder law issues are complex and comprehensive. Many attorneys practice exclusively in this area, because the legal issues facing the nation’s growing number of seniors are very unique, encompassing many different matters, including securing healthcare, at-home support, inheritance planning, and more.

Unfortunately, some try to use generic shortcuts to handle some of these matters, instead of creating comprehensive plans that take different issues into account. For example, some many that adding a child’s name onto a bank account or having a single Power of Attorney drafted are enough to solve any issues that might arise.

Examples continue to mount, however, illustrating how these shortcuts can cause serious problems. That is particularly true when disagreements arise between family members who were given various power and control over the affairs of the senior.

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.

Reuters published a story this week on the latest audit of the New York Medicaid system which has given leverage to those hoping to use financial worry to trim the system and the state budget overall.

We have previously discussed the audit by the Centers for Medicare and Medicaid Services which found that the federal government overpaid the state by billions of dollars in recent years. The actual audit is still not yet complete, but federal officials are set to conclude by the end of this month. It is only then that the full scope of the situation will be known and the effect considered. The story notes how the overpayment may ultimately wreck havoc on the state’s financial health just as some were hoping things were finally settling down.

All of this has placed a pall over the current work in Albany where legislators are working to approve the state’s next budget–around $140 billion.

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