Author Archives: Evan Farr
Q: My parents are in an independent living home in Virginia. I recently read a story about a nurse who refused to give CPR to a dying woman at a California independent living home. Was she legally right to refuse giving CPR and could this happen in Virginia?
A: The unfortunate story that occurred at Glenwood Gardens in California is disturbing on many levels and raises important legal and ethical questions for debate and review.
Starting with the issue of the facility type first, Glenwood Gardens and the place where your parents are staying are Independent Living facilities. Independent living facilities may consist of fully contained apartments or even stand-alone residences and are sometimes called retirement communities. Some facilities have communal dining rooms and provide housekeeping and laundry services, and while many have emergency call buttons in the apartments, typically there are no nurses or medical professionals on staff. The residents are presumed to be able to fully care for themselves.
In Virginia, Independent Living facilities are not licensed and not subject to any of the licensing regulations that apply to assisted living facilities. The facilities are therefore free to create their own policies regarding handling of emergencies.
In the Glenwood Gardens situation, there is conflicting information regarding whether the facility employee is a licensed nurse or not. If she is a licensed nurse her duties and obligations may be different than if she is not. In addition, her obligations may also depend on whether her position with the company was specifically as a nurse who was expected to render medical care to residents. Since this is an Independent Living facility it is unlikely that the course and scope of her position, even if she was a nurse, would include rendering emergency medical assistance.
Virginia, like many states, does have “Good Samaritan” laws (Code of Virginia – Section 8.01-225) to protect those who render emergency medical or nonmedical care at the scene of an emergency from civil liability resulting from any act or omission. However, these laws do not compel medical personnel to act in such situations, but simply provide encouragement to act.
This sad incident brings to light many ethical and legal issues. Choosing the best senior living situation can be tricky. Understanding the different types of facilities, their licensing, and the services provided is paramount to meeting the resident’s and family’s expectations. When choosing a facility it is important to understand the facility’s policies on emergency management. Also, before you decide on the best living situation for yourself or a loved one, make sure your Advance Medical Directives are complete and available when needed. This will ensure, in most cases, that your loved ones desires are communicated to physicians and loved ones, and that they take your preferred course of action regarding all forms of medical treatment.
An Advance Medical Directive (also called a Medical Power of Attorney or a Health Care Power of Attorney) authorizes another person (called your “Medical Agent”), to make decisions with respect to your medical care in the event that you are physically or mentally unable to do so. This document includes provisions that used allow you to indicate your wishes concerning the use of artificial or extraordinary measures to prolong your life artificially in the event of a terminal illness or injury. You will also use this document to indicate your wishes with regard to organ donation, disposition of bodily remains, and funeral arrangements. Your Advance Medical Directive should also set forth your preferences with regard to organ donation, funeral arrangements, and disposition of remains. Our proprietary Four Needs Advance Medical Directive(TM) contains all of these elements plus our proprietary Long-Term Care Directive, which addresses a host of issues that might arise if you wind up needing Long-Term Care.
In order to be easily accessible when needed, your Advance Medical Directive should be registered with an electronic archive service that can immediately fax the document to any desired destination. This firm will provide such registration service to you at no charge unless you would prefer that the document not be registered. Don’t have a Advance Medical Directive or planning in place? Call The Fairfax Elder Law Firm of Evan H. Farr, P.C. at 703-691-1888 to make an appointment for a no-cost consultation.
There are treatments available now that most families coping with Alzheimer’s or other dementia never hear about that can significantly improve their quality of life.
Called non-pharmacologic therapies (NPTs), these treatments do not come in a pill. Instead, NPTs such as personal counseling and occupational therapy-based strategies are proven to improve the quality of life for people with dementia and their families. NPTs support families and teach them the skills they need to protect their own health and cope with the intense demands of caregiving and help people with dementia stay independent and safe for as long as possible. Some of the NPTs currently used are proven programs that are actually more effective than any known drugs for Alzheimer’s disease.
One example of an NPT, developed at NYU, includes individual and family counseling to reduce conflict and improve communication among family members. Those caring for a spouse with dementia who received the NYU Caregiver Intervention were more satisfied with social support and less depressed, less bothered by difficult behaviors, had better physical health and were able to keep their ill spouses at home longer than those receiving usual care.
Another model developed at Thomas Jefferson University in Philadelphia, employs occupational therapists to assess the patient with dementia and identify preserved capabilities as well as the caregiver’s needs. Families are then provided with strategies to manage day to day care, such as communication techniques, safe-proofing the home, establishing daily routines and engaging the individual with dementia in meaningful activities. Families who participated have reported feeling more confident and less upset, and found that their ill family member functions better and exhibits fewer challenging behaviors.
Another NPT that is now being used is a stimulator device surgically implanted into the brain of a patient in the early stages of Alzheimer’s disease. The implanted device is seen as a possible means of boosting memory and reversing cognitive decline, and has already been used in thousands of people with Parkinson’s. The surgery involves drilling holes into the skull to implant wires into the fornix on either side of the brain. The wires are attached to a pacemaker-like device, which stimulates the brain with tiny electrical impulses generated 130 times a second. The patients don’t feel the current.
Lastly, another effective non-drug Alzheimer’s treatment used to jog memory is music. In nursing homes that use music, the personalized playlists are often meaningful songs chosen by loved ones. According to Alzheimer’s experts, music helps patients become more alert, more cooperative, more attentive, and more engaged. In many cases, even if they can’t recognize loved ones and they’ve stopped speaking, when the patients hear music, they “come alive”.
Geri Hall, a clinical nurse specialist at the Banner Alzheimer’s Institute, explains how music activates a part of the brain that stays active despite the dementia. “There is something about music that gets through to Alzheimer’s patients right up until the very end of the disease,” she said, adding that “familiar music from the past can help people with dementia feel at home. It calms them, increases socialization, and even decreases the need for mood controlling medications.” Read our blog post about Alzheimer’s and Music.
Alzheimer’s slowly robs its victims of a lifetime of memories and the ability to perform simple daily tasks. Instead of focusing on drug treatments, many of which have failed in clinical trials, it may be a good idea to try non-drug treatment options. These programs have been proven effective in randomized controlled trials. And, unlike drug therapy, there are no adverse side effects. There is also an economic argument to be made for better caregiver support. Nearly 11 million family and other unpaid caregivers provided an estimated 12.5 billion hours of care to people with dementia. This care is valued at nearly $144 billion. The country can’t afford the consequences of these caregivers becoming too burned out or sick to carry on. See our recent blog post about the rising cost of dementia.
Moving a person with dementia to a nursing home, while sometimes unavoidable, is expensive. The NPTs described have helped to delay nursing home placement for more than a year. Unfortunately, you cannot delay the inevitable forever, but what you can do is plan ahead for you and your loved ones. Do you or a loved one need nursing home care in the near future or are you looking to plan ahead? Call 703-691-1888 to make an appointment for a no-cost consultation at The Fairfax Elder Law Firm of Evan H. Farr, P.C. We can meet with you, access your situation and determine strategies for your long-term care plan.
Q. My ten year old son, Cole, was diagnosed with an Autism Spectrum Disorder (ASD) when he was six. He is in a class of 20 children and there are two other boys and a girl who also have an ASD, all ranging in severity. These children spend half the time in the typical class and half the time in special education. When I was growing up, the only person I knew with autism was my friend’s brother, who didn’t talk and was very anxious about being around others. Why is ASD so common now, as opposed to 30 years ago, and what can I and other parents do to plan for our special needs children?
A. Autism spectrum disorder, or ASD, is a group of developmental disabilities that can cause significant social, communication and behavioral challenges. ASD affects each person in different ways, thus their impairment can range from mild to severe, but all those afflicted with autism share problems with social interaction.
What we know now is that there is no one cause of autism just as there is no one type. Different genes increase the probability of a child developing autism. We know that children who have a sibling or parent with autism are at a much higher risk of also having the condition or another developmental disorder. Genes may be affected by advanced parental age at time of conception.
But why is autism’s prevalence increasing? Thirty years ago, the rate of autism was typically quoted as 4 in 10,000. The most recent rate reported is 1 in 50. This is an alarming increase from one in every 88 children reported by the Centers for Disease Control and Prevention just four years ago. Factors that have brought the startling levels of autism to our attention include:
- Better Understanding: Thirty years ago, autism was first introduced as a separate diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders III (DSM-3). Prior to that time, clinicians using the DSM applied other categories such as childhood schizophrenia.
- More Awareness: Since the early ‘80’s, there has been extraordinary growth in awareness – both for professionals and parents. Pediatricians now screen for early warning signs, as do parents. These actions have all led to a much greater awareness of the symptoms of autism which has translated to more diagnoses being made. In addition, the increased awareness has permitted older kids to be diagnosed when the signs earlier in life were not recognized as autism.
- Expansion of the Symptoms: Diagnostic changes that recognized autism as a spectrum, now referred to as Autism Spectrum Disorder (ASD), have helped capture the wide range of symptoms that go beyond “classic” autism. These symptoms can include social, communicative, and repetitive/stereotyped behaviors. Since autism became a spectrum disorder, many youth were diagnosed who would not have been in past years.
- Changes in Etiological Factors: Less understood is the role of new causative factors that increase the risk for ASD. Much attention is being given to environmental factors and there is the suggestion that specific genetic mutations may be linked to autism.
Autism has come a long way in the past 30 years. We know now that autism is very common and that it may be influenced by genetic and environmental risk factors that are not well understood at this time. For these reasons, it is important for doctors, scientists, and awareness groups to keep researching the causes of autism, and to continue to promote awareness of the early signs and symptoms in order to support early diagnosis and intervention.
How can you plan for your son? More than $13 billion a year is spent to care for individuals with autism. For the average affected family, this translates to $30K per year. Many parents believe that needs-based programs such as Supplemental Security Income (SSI) and Medicaid will be enough to take care of their family members with special needs when they are gone. This is a common misconception.
SSI is the federal needs based program that many special needs children and adults may be eligible for if they meet certain income limits. Many special needs children and adults may also get Medicaid to pay for hospital stays, doctor bills, prescription drugs, and other health costs. However, once a person with special needs exceeds the $2,000 a year resource limit, he or she is no longer eligible for SSI or Medicaid.
Twenty million American families have at least one member with special needs, such as ASD, cerebral palsy, mental illness, blindness, and others. Parents of those with special needs are tasked with planning for their children throughout their lifetime, as many of them will outlive their parents but might not be able to support themselves and live independently.
We here at The Fairfax Elder Law Firm of Evan H. Farr, P.C., know that the majority of American families who have a loved one with special needs require a Special Needs Trust. These families typically have very little in tangible assets, second mortgages on their homes, and little to no savings (likely due to paying for the costly therapies). As a parent or guardian, you want to ensure that your child with special needs will remain financially secure even when you are no longer there to provide support. A Special Needs Trust is a vehicle that provides assets from which a disabled person can maintain his or her quality of life, while still remaining eligible for needs-based programs that will cover basic health and living expenses.
In your situation, you can create a Special Needs Trust to benefit Cole that provides instructions as to the level of care you want for him. After you are gone, the people you have chosen to manage the trust (trustees) can spend money on certain defined expenses for Cole’s benefit without compromising his eligibility for needs based programs.
We invite you to call 703-691-1888 to make an appointment for a no-cost consultation with The Fairfax Elder Law Firm of Evan H. Farr P.C. to learn more about special needs planning.
Maryann Pittas, the victim of a car accident, was a patient in a nursing home for about six months. A few weeks after she was released, her son received the nursing-home bill of $93,000. He was beside himself when the facility tried to collect from his family because his mother couldn’t pay the bill.
After the case went through the court system, the Pennsylvania court found in favor of the nursing home, based on the son’s ability to pay. By holding the son liable for the $93,000, the Pennsylvania court enforced Pennsylvania’s “filial responsibility” law that makes a child responsible for supporting his or her indigent parents if the child has sufficient financial ability to do so.
“At the time, I didn’t even know that they were very poor and basically living off of my father’s Social Security check,” says the son, who found out the hard way that his family should have planned ahead.
As your parents age, they may spend months or years in a nursing facility. What happens if one of them is in need of long-term care and is unable to pay for it? Currently 30 states, including Virginia, have “filial responsibility” laws that can be used by nursing homes and other long-term care facilities to seek reimbursement for unpaid bills from a patient’s children if the patient cannot pay the bills themselves. According to these laws, adult children are legally responsible (at least on paper) to pay for necessities like food, clothing, shelter and medical attention for indigent parents.
Even with these laws in place, the practice of nursing homes turning to them to collect unpaid debts is not too widespread, but as you can see from the Pittas’ case, it can happen. For the full text of the Pennsylvania court’s decision in the Pittas case, go to: http://www.pacourts.us/assets/opinions/Superior/out/A36025_11.pdf.
How can you avoid parental support pitfalls? Medicare may cover short-term rehabilitation in a nursing home if certain conditions are met, but only for a maximum of 100-days. At that point, residents without long-term care insurance must pay for their own care unless they have done proper Medicaid asset protection planning, which is an absolute necessity if you want to avoid the possible application of Virginia’s filial responsibility law. Virginia’s law (Virginia Code Section 20-88) states as follows:
“It shall be the joint and several duty of all persons eighteen years of age or over, of sufficient earning capacity or income, after reasonably providing for his or her own immediate family, to assist in providing for the support and maintenance of his or her mother or father, he or she being then and there in necessitous circumstances.”
However, there is additional critical language in Virginia’s statute – it says that this law
“shall not apply if . . . a parent is otherwise eligible for and is receiving public assistance or services under a federal or state program.”
In other words, Virginia’s filial responsibility law does not apply if the parent is receiving Medicaid! This exception is crucial to understand and means that it is essential that adult children help their parents plan to receive Medicaid if these adult children don’t want to wind up being responsible for their parent’s nursing home care as happened in the Pittas case.
The Pittas family’s experience serves as a warning for middle-aged children with parents who are racking up nursing home bills or who may in the future need nursing home care . The only way you can make sure you do not fall victim to a filial support action is by planning ahead. Children have to be proactive regarding how their parents are financing their long-term care. Some families of modest means may assume Medicaid will cover a parent’s care once the parent has depleted savings and other resources. But it’s a huge mistake to assume that Medicaid will be easy to obtain.
Medicaid laws are the most complex laws in existence, with 8 separate bodies of law (4 at the Federal level and 4 at the state level) dealing with Medicaid and Medicaid eligibility. To do proper Medicaid asset protection planning, families need the help of an experienced elder law attorney, preferably a Certified Elder Law Attorney such as Evan H. Farr, CELA. The best time to do Medicaid Asset Protection planning is now. Whether your parents are years away from needing nursing home care or are already in a nursing facility, or somewhere in between, the time to plan is now, not when your parents are about to run out of money. Call The Fairfax Elder Law Firm of Evan H. Farr, P.C. today at 703-691-1888 to make an appointment for a no-cost consultation.
Nancy and Nick have three children — Emmitt, Nicole, and Alexa. Very warm and loving parents, Nancy and Nick make education a top priority, and hope to instill their deep-rooted culture and values in their children. Neither Nancy nor Nick want to think about not being there to raise their children. If Nancy and Nick choose not to make a decision and take no action, who will care for their children should the unthinkable happen to them?
Various scenarios, none of them ideal, could happen should Nancy and Nick not choose a guardian for their children. Their relatives could end up arguing in court over who gets the children — or their relatives could agree but not on the people that Nancy and Nick would have chosen. Even worse, a court could end up choosing their guardian for them. That’s why it’s important for Nancy and Nick and for your family to nominate a guardian while it’s still up to you. Here are some actions to take to help you make your best choice:
- Make a list of all the people you know who you would trust to take care of your children, including family members, extended family, close friends, people you know from your place of worship, or even child care providers with whom you and your children have a special relationship.
- Consider values and philosophies. Ask yourself which people on your list most closely share your values and philosophies with respect to your religious/spiritual beliefs, moral values, child-rearing philosophy, educational values, and social values.
- Consider whether each couple or person on your list is a good fit. Would they truly love your children, be good role models, have patience parenting your children, show affection, and are they mature enough to take on the guardian role?
- Think about how raising your children would fit into their lifestyle.
- If they’re older, do they have the necessary health and stamina? Would they really want to be parents of a young child at their stage in life?
- Do they have other children? How would your children get along with theirs?
- How close do they live to other important people in your children’s lives?
- If a married couple divorced or one spouse died, would you be comfortable with either of them acting as the sole guardian, or would want an alternate married couple to become guardian instead.
- Trust your instincts. If one couple or person meets all of your criteria, but doesn’t feel right, don’t choose them. By the same token, if someone feels much more right than any of the others on your list, there’s probably a good reason for it and you probably want to trust your gut instinct. Make your primary choice, then some backup choices. Ideally, both you and your spouse agree on your choices.
- Use a Child Protection Plan to select a temporary custodian as well as your Last Will and Testament to nominate your permanent Guardian. Temporary custodians may be appointed if both parents become temporarily unable to care for their children – for example, as the result of a car accident. Depending on your choice for permanent guardians (for example, if your permanent guardians work and live in another state or another country and will have to take leave and make travel arrangements to come and care for your children), you may want to designate different people to act as temporary custodians. Temporary custodians are designated via a Child Protection Plan rather than via your Last Will and Testament.
- Consider a guardianship panel. Because it’s difficult to predict what your children’s needs will be as they grow older, consider appointing a “guardianship panel” to decide who would be the best guardian when and if it becomes necessary. Choose trusted relatives and friends to make up the panel. The panel can consult with your children and assess their needs and desires to make the most appropriate choice based on the current situation.
Once you’ve narrowed down your choices, talk to everyone involved. Be sure to confer with the people you’d like to choose to ensure they’re willing to be chosen and would feel comfortable acting as guardians. If your children are old enough, you may even want to talk with them to get their input. Create a Letter of Intent to convey information about your children, your parenting values and your hopes and dreams for your children. Set up an appointment with a Certified Elder Law Attorney, such as Evan H. Farr, to prepare the legal documents that are required to put your wishes into action.
If you’ve chosen friends over relatives or a more distant relative over a closer one, be sure to explain your decision in writing. That way – in the unlikely event your choice is challenged by people who feel they should have been chosen – a court should readily uphold your decision, knowing you’ve made your choice for good, solid reasons.
Set up a trust that will hold the assets you pass to your children, and instruct the trustee to provide necessary financial assistance to the guardians. Create specific instructions about special things you’d like the trust funds used for (for example, a particular summer camp, piano lessons etc.).
Having children means always planning ahead and thinking about the future, even as you try to enjoy the present and watch your children grow and thrive. Nominating a guardian (and, if necessary, a temporary custodian) for your children gives you the peace of mind that your children will be protected if something happens to you. Call 703-691-1888 and make an appointment for a no-cost consultation at The Fairfax Elder Law Firm of Evan H. Farr, P.C.
Q. My 86 year old mother had a stroke last week, was in the hospital, and was moved to a nursing home for rehabilitation. I was wondering about Medicare coverage. Does Medicare cover nursing home stays? What if she needs more than the 100 days I read about?
A. Many people believe that Medicare covers nursing home stays. It is true that Medicare covers up to 100 days of short-term rehabilitation per illness, but there are a number of requirements that must be met before this short-term rehab stay will be covered. The result of these requirements is that Medicare recipients are often discharged from a nursing home before they are ready.
In order for a nursing home stay to be covered by Medicare:
- The patient must enter a Medicare-approved “skilled nursing facility” or nursing home within 30 days after a hospital stay that lasted at least three days.
- The short-term rehabilitation care received in the nursing home must be for the same condition as the hospital stay. In addition, you must need “skilled care.” This means a physician must order the treatment and the treatment must be provided daily by a registered nurse, physical therapist, or licensed practical nurse.
- Finally, Medicare only covers “acute” care as opposed to custodial care. This means it covers care only for people who are likely to recover from their conditions, not care for people who need ongoing help with performing everyday activities, such as bathing or dressing.
It is important to understand that Medicare does not pay one penny for long-term care. (This section is excerpted from Evan H. Farr, CELA’s book ”Nursing Home Survival Guide- Helping You Protect Your Loved Ones Who Need Nursing Home Care by Preserving Dignity, Quality of Life, anFinancial Security,” available on Amazon.com)
“If you are enrolled in a traditional Medicare plan, and you’ve been in the hospital at least three days, and you are admitted directly from the hospital into a rehab facility (which are typically skilled nursing facilities for short-term rehabilitation (i.e., therapy and treatment designed to make you better), then Medicare should pay the full cost of this short-term rehab stay for the first 20 days, and may continue to pay part of the cost of the short-term rehab stay for the next 80 days — with a per day deductible that you must pay privately (although there are Medicare supplement insurance policies that sometimes cover that deductible). There is also a Medicare Managed Care Plan, for which the 3-day hospital stay may not be required, and for which the deductible for days 21 through 100 is waived, provided certain strict qualifying rules are met But whether the plan is traditional Medicare or Medicare Managed Care (MMC), the nursing home resident must be receiving daily rehabilitative care and must be improving. Medicare does not pay for long-term care i.e., for custodial nursing home stays or in-home care. In a best case scenario, traditional Medicare or MMC will provide some coverage for the hospital stay and rehabilitation of up to 100 days for each “spell of illness” (although in our experience coverage usually falls far short of the 100-day maximum). If you recover sufficiently that you do not require a Medicare-covered care benefit for 60 consecutive days, you may be eligible for another benefit period, i.e., another 100 days of Medicare coverage, but the illness or disorder must not be a chronic degenerative condition from which you will not recover. What happens if you’ve used up the 100 days of coverage and still need more rehabilitation, or if you need to move into long-term nursing home care? You’re back to one of the alternatives outlined above: long-term care insurance, paying the bills with your own assets, or qualifying for Medicaid.”
Did you know that nursing homes in Northern Virginia cost 10-12K a month? For typical middle-class people who pay out of pocket, these costs will most likely drain all of their hard-earned assets pretty quickly. For more information, read our recent blog post “How Can I Afford a Nursing Home?”.
Do you have a loved one who is in a nursing home or nearing the need for nursing home care? Or are you simply looking to plan ahead in the event nursing home care is needed in the future? Life Care Planning and Medicaid Asset Protection is the process of protecting your assets fro having to be spent down in connection with entry into a nursing home, while also helping ensure that you or your loved one get the best possible care and maintain the highest possible quality of life, whether at home, in an assisted living facility, or in a nursing home. Learn more at The Fairfax Elder Law Firm of Evan H. Farr, P.C. website. Call 703-691-1888 to make an appointment for a no-cost consultation.
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The following was excerpted from Evan H. Farr, CELA’s new book, entitled “Nursing Home Survival Guide: Helping You Protect Your Loved Ones Who Need Nursing Home Care by Preserving Dignity, Quality of Life, and Financial Security.”
Buy the book on Amazon.com.
“One of greatest concerns people have about nursing home care is how to pay for it. There are basically four ways to pay for the cost of the care provided by a nursing home:
- Private Pay. This is the method many people must use at first. It means paying for the cost of a nursing home out of your own pocket. Unfortunately, with nursing home bills of more than $12,000 per month at some facilities, few people can afford to pay on their own for a long-term stay in a nursing home. Even those who can afford to do so often desire to explore other options — options that allow them to retain some or all of their assets for other important needs, while still permitting them to pay for nursing home care.
- Long-Term Care Insurance. If you have long-term care insurance coverage, this could help pay the costs of needed home care or nursing home care. Unfortunately, only about ten percent of the population carry long-term care insurance, so most people facing a nursing home stay do not have this type of coverage in place. Many people who would like to purchase this type of coverage find that they can not afford it. Read more about long-term care insurance on page 34.
- Department of Veterans Affairs. The Department of Veterans Affairs (VA) primarily pays for long-term care through the Veterans “Aid and Attendance” Special Pension Benefit payments. In some parts of the country, there are also nursing homes that are run by the Department of Veterans Affairs. You will find additional information about the Veterans “Aid and Attendance” Special Pension starting on page 46.
- Medicaid. This is a combined federally-funded and state-funded benefit program, administered by each state, that can pay for the cost of a nursing home if certain asset and income tests are met. According to AARP, about 70 percent of nursing home residents are supported, at least in part, by Medicaid. Medicaid qualification and eligibility is discussed in greater detail starting on page 52.
A WORD ABOUT MEDICARE
You will notice that Medicare is NOT listed among the sources of funds used to pay for long-term care in a nursing home. This is because Medicare does not pay a penny for long-term care, ever. Medicare is the national health insurance program primarily for people 65 years of age and older, those under age 65 who have been disabled for at least 24 months, and people with kidney failure. Medicare may provide some coverage for short-term (up to 100 days) rehabilitation in a nursing facility, provided you continue to get better from the rehabilitation, but you must meet certain strict qualification rules, which will be discussed in greater detail starting on page 36 .”
About “The Nursing Home Survival Guide- Helping You Protect Your Loved Ones Who Need Nursing Home Care by Preserving Dignity, Quality of Life, and Financial Security.”
In the book, The Nursing Home Survival Guide- Helping You Protect Your Loved Ones Who Need Nursing Home Care by Preserving Dignity, Quality of Life, and Financial Security,” Mr. Farr provides invaluable information and guidance to families dealing with the possibility of nursing home care and struggling to make the best decisions for themselves or their loves ones. Mr. Farr, a nationally-renowned Best-Selling author and frequent educator of attorneys across the U.S., uses his mastery of the subject to educate consumers about the ever-changing landscape of nursing home care in America and, most importantly, how to get the best care and how pay for that care without going broke.
Readers can get expert advice on diverse topics ranging from the basics — how do you select the best facility, what does Medicare cover, how to get the best long-term care insurance — to the advanced, such as Veterans Aid & Attendance Planning, Medicaid Asset Protection, Pre-Need Medicaid Planning, and Medicaid Crisis Planning. Mr. Farr provides access to a valuable Nursing Home Evaluation Tool and insights using case studies featuring some of the most common Medicaid Asset Protection strategies and how they pertain to real-life situations. Readers will also become educated about the rights of nursing home residents, estate and Incapacity Planning, How to Find the Best Lawyer, and more. The “Nursing Home Survival Guide- Helping You Protect Your Loved Ones Who Need Nursing Home Care by Preserving Dignity, Quality of Life, and Financial Security” is now available on Amazon.com.
Do you have a loved one who is in a nursing home or nearing the need for nursing home care? Or are you simply looking to plan ahead in the event nursing home care is needed in the future? Nursing homes in Northern Virginia cost $10-$12K per month. Life Care Planning and Medicaid Asset Protection is the process of protecting assets from having to be spent down in connection with entry into a nursing home, while also helping ensure that you or your loved one get the best possible care and maintain the highest possible quality of life, whether at home, in an assisted living facility, or in a nursing home. Learn more at The Fairfax Elder Law Firm of Evan H. Farr, P.C. website. Call 703-691-1888 to make an appointment for a no-cost consultation.
Q: I have a 75 year old father who lives alone in his home. He doesn’t have an in-home caregiver, but has lots of friends and family who check in on him regularly. Since he served during the Vietnam War, he has had flashbacks that still affect him and keep him up at night. He suffered at least one stroke in the last 5 years, has trouble walking, seeing, and hearing things, left the stove on recently and sometimes forgets to take his medication.
I think he would do so much better if he moved to an assisted living community. Plus I wouldn’t worry as much knowing that he had appropriate care and supervision. The problem is he’s resistant to the thought of this change. How do I talk to him?
A: The decision to help your father move out of his current home is a complex one — both emotionally and practically.
If he is showing signs that living alone is a strain, it may be time for a talk. Before having the talk, be prepared for the psychological roadblocks you’re likely to hit when you broach the subject. The following tips will help make the conversation more productive, and maybe even pleasant:
- Understand that your father’s home represents control. You’re asking your father to let go of control at a time when age itself may be making him feel he’s losing control over so much else — fundamentals like mobility, vision, hearing, his very ability to navigate the world.
- Look at housing from his point of view. Visit the assisted living facility that you’d consider for your father. Imagine you were in his shoes on your way in the door. Think about how he may feel in making this place his home.
- Be tactful and gentle. Broach the subject of where to live in a neutral way and you may find that your father harbors the same fears for current and future safety and security that you do. Find out what your father fears most about moving and about staying before launching into your own worries and what you think ought to be done
- Remind yourself that he may come around to the idea. Attitudes change, and the most resistant older adults sometimes wind up as the happiest retirement community residents if they eventually realize they need help. But if he doesn’t wind up moving when you think he should, you can still support him by making his housing situation as safe and comfortable as possible.
- Keep in mind that in the end, it’s his decision, not yours — and communicate that thought to him. As long as he’s mentally competent, acknowledging that he’s in charge of his own life will make the process of helping him navigate the housing maze more positive and productive for all involved.
If, on the other hand, your father has a full life, a close neighborhood and community connections, and seems to be thriving, it’s worth exploring as many in-home care options as possible before raising stress levels by pressing a move from a beloved home. We here at The Fairfax Elder Law Firm of Evan H. Farr, P.C. hope you and your father talk and listen to one another and come to a resolution that works best for his happiness and well-being, and your concerns about his living alone and being able to take care of himself.
Whether the outcome is in-home care or assisted living, we suggest that you plan ahead in the event nursing home care is needed in the future. Life Care Planning and Medicaid Asset Protection is the process of protecting assets from having to be spent down in connection with entry into a nursing home, while also helping ensure that you or your loved one get the best possible care and maintain the highest possible quality of life, whether at home, in an assisted living facility, or in a nursing home.
The Fairfax Elder Law Firm of Evan H. Farr, P.C. has also recommended to clients like your father that he may be eligible for the Veterans Aid and Attendance Benefit, but may also need Medicaid for nursing home care in the future. To be eligible for the Veterans Aid and Attendance Benefit, beneficiaries must be at least 65 years old (or totally disabled), veterans or married to veterans who served during a wartime period, and must have been not dishonorably discharged. Applicants must also need help with at least one activity of daily living: eating, walking, dressing, bathing, using the toilet, or adjusting prosthetic devices. Those who live in nursing homes or require in-home care, or are blind, may also be eligible. Please call 703-691-1888 to make an appointment for a no-cost consultation.
Transitioning a loved one into assisted living or a nursing home isn’t easy for most families, especially if your loved one has Alzheimer’s. For a person with Alzheimer’s disease, changing the routine and moving into an unfamiliar environment make the move especially daunting. If you’re helping a loved one who has Alzheimer’s move into a care facility, these are some tips to make the transition as comfortable as possible:
- Make frequent visits before the move. Consider carefully whether to include your loved one in these visits. If your loved one is interested, it might make sense to bring him or her with you. If you sense that a visit would only create stress and anxiety, visit without your loved one.
Speak with the staff about your loved one’s background and any special needs. Provide details on your loved one’s medical and mental health history, including a detailed medication list.
- Before the move, make your loved one’s new room or space look and feel as familiar as possible. Decorate the area with a treasured quilt, a shelf with special items, a favorite chair or other meaningful possessions. Familiar belongings can trigger feelings of connectedness and ownership, as well as boost your loved one’s sense of security.
- Bring pictures of loved ones and friends, memory books or photo albums. Reminiscing about the past can help a person who has Alzheimer’s bring reassuring memories into the present. Label the pictures to help staff members or others identify the people in your loved one’s life and encourage conversations about the past.
- As you’re preparing your loved one’s space, be careful with heirlooms and irreplaceable items. Consider bringing items that can be replaced easily if necessary — such as copies of old photos instead of the originals.
- On the day of the move, follow your loved one’s normal routine as much as possible. If you can, handle the move during your loved one’s best time of day — whether it’s in the morning or the afternoon.
While you’re moving, do your best to stay positive. Your attitude can help your loved one feel safe and secure in the new environment. Once your loved one is settled, trust the staff to help with the next big step — your departure. Rather than making a big deal about your leaving, the staff might engage your loved one in a meaningful activity while you walk away.
Leaving your loved one in the new home or facility might be difficult for you — both on the day of the move and in the weeks and months that follow. Feelings of grief, loss and guilt are normal. Keep in mind that it might take your loved one a couple of weeks to a couple of months to become acclimated to his or her new living arrangements. Trust the facility’s advice as to whether to visit your loved one regularly during this transition time or to stay away. Staying away during the transition time may be very difficult for you, but may be better for your loved one by allowing your loved one time to acclimate to the new surroundings without being frequently reminded of the old.
Once your loved one is settled in the care facility, be sure to read our article about Looking out for a Loved One in a Nursing Home.
Do you have a loved one who is in a nursing home or nearing the need for nursing home care? Or are you simply looking to plan ahead in the event nursing home care is needed in the future? Make sure you are prepared financially. Persons with Alzheimer’s and their families face special legal and financial needs. At the Fairfax Elder Law Firm of Evan H. Farr, P.C., we are dedicated to easing the financial and emotional burden on those suffering from Alzheimer’s and their loved ones. Nursing homes in Northern Virginia cost $10-$14K per month. We help protect the family’s hard-earned assets while maintaining your loved one’s comfort, dignity, and quality of life by ensuring eligibility for critical government benefits.
Life Care Planning and Medicaid Asset Protection is the process of protecting assets from having to be spent down in connection with entry into a nursing home, while also helping ensure that you or your loved one get the best possible care and maintain the highest possible quality of life, whether at home, in an assisted living facility, or in a nursing home. Call us today at 703-691-1888 to make an appointment for a no-cost consultation.
Organizing life can be difficult, particularly when you are coordinating your care or that of a loved one. Doctors’ appointments, medication schedules, and other activities can seem overwhelming. But, your smartphone or tablet can prove to be a big help in these and other areas. If you’re a child caregiver, consider adding an extra smart phone or tablet to your plan for your parent, or re-purposing your old smartphone or tablet when it’s time for you to upgrade.
Although there is no single app that can ever take the place of medical advice and diagnosis from a physician, these apps can come in handy for day-to-day health questions and concerns, exercising your brain, tracking your food intake and retrieving important information:
- The WedMD app allows you to access first aid treatment suggestions and research common illnesses.
- Pain Care records pain levels, duration, characteristics, mood and triggers in order to automatically share this information with physicians who can prescribe or adapt medications.
- MedWatcher pushes safety alerts for medical devices and for drugs to your tablet or smart phone. It also allows the user to report adverse events (and side effects) directly to the FDA. This feature has the potential to make devices/drugs safer for everyone involved.
- Instant Heart Rate uses the camera on your smartphone to detect the pulse from your fingertip.
- Magnifying Glass with Light – Allows anyone with poor vision to read or locate things a bit easier
- GoMeals gives you tools and information to help you succeed at healthy eating. It features three applications in one–A nutritional database, powered by CalorieKing, combined with a restaurant locator and a food tracking tool.
- CogniFit is the ultimate brain training app. Play different brain games to challenge your mind and train your cognitive skills.
- Pillboxie is the easy way to schedule reminders for yourself and remember your meds.
- Words with Friends is a multi-player word game where players can take turns building words crossword puzzle style with an opponent in a manner similar to the classic board game.
- Find My Phone will help you locate your missing device on a map, play a sound, display a message, remotely lock your device, or erase all the data on it.
- iBooks includes the iBookstore, where you can download the latest bestselling books or your favorite classics – day or night.
- iCam allows you to remotely monitor multiple live video and audio webcam feeds from your iPhone, iPod touch or iPad over WiFi, 3G and EDGE. A great use for this app is for a child caregiver to remotely monitor aging parents to make sure that they are ok when left alone..
- Elder 911 has useful info for caregivers and others.
- Phonotto – simplifies all phone functions for seniors
- Springpad gathers all those things you want to remember in an accessible place and then provides more information about them, all within the palm of your hand. It’s like having a reliable and efficient personal assistant with you always.
- Remember the Milk app will not only remind you to pick up milk, but will also direct you to the nearest supermarket.
We here at the Fairfax Elder Law Firm of Evan H. Farr, P.C. are pleased to see all of the advances in technology and apps available to help improve seniors quality of life, health, and well-being. Now that you know about these apps and you’ve planned for everything from what to pick up at the grocery store to setting up reminders to take your meds, it is time to plan for your future and for your loved ones. Evan H. Farr is a Certified Elder Law Attorney with a focus on helping protect seniors and their families by preserving dignity, quality of life, and financial security. Call us at 703-691-1888 to make an appointment for a complimentary consultation.