Category Archives: Assisted Living
While placing a loved one in a nursing home is a difficult decision, there may come a time when it is the right one. It will help if you do your homework and trust your instincts.
According to the Department of Health and Human Services, the nation’s nursing homes provide care to over 1.5 million people. Over 90% of these residents are over age 65. Most of the residents are frail and require round-the-clock supervision due to dementia.
Things You Need to Know
A nursing home is a residence that provides room, meals, nursing and rehabilitative care, medical services and protective supervision to its residents. While someone coming from the hospital may require the services of many long-term care professionals such as nurses, therapists and social workers, a nursing home is not a hospital (acute care) setting. The goal at a nursing home is to help people maintain as much of their independent functioning as possible in a supportive environment.
Choosing a Facility
One of the first things to consider when making a nursing home choice is the needs of the individual for whom you’re providing care, suggest experts at the MetLife Mature Market Institute®. Make a list of the special care they need, such as dementia care or various types of therapy.
If the person is hospitalized, the discharge planner and/or social workers can assist you in assessing the needs of the individual and locating the appropriate facility.
If you are choosing a nursing facility for someone who is presently at home, ask for referrals from your physician, Area Agency on Aging, friends, and family.
Other factors such as location, cost, the quality of care, services, size, religious and cultural preferences, and accommodations for special care need to be considered.
When you’ve located a few facilities that you’d like to consider more thoroughly, plan on visiting each one, both with scheduled and unscheduled visits, and at different times and on different days of the week.
As you are walking around, take note of what you hear and don’t hear. Is it silent? Is there activity? How clean does it look? Are the residents dressed appropriately for the season? Most importantly, find out the ratio of nurses to residents is and what is the staff turnover rate?
When you’ve finally decided on a facility, you should know your rights and those of your family member. Before you or the resident sign the admissions agreement, understand what you’re signing, and do not sign any paperwork unless everything has been fully explained.
The admissions contract should, at a minimum, contain the daily room rate, reasons for discharge and transfer from the nursing home, and the policy regarding payment of the daily room rate if the resident goes to the hospital or the family brings the resident home for a short period of time.
You may question if you’re really making the right decision to place your loved one in a facility at all. Remember, you can do no more than your best, and if you’ve done that, neither you nor your family member can ask any more of you.
Budgeting is part of any effective Life Care Plan and becomes even more important when seniors experience a big life change, such as moving into an assisted living facility, losing a spouse or having a drastic change in health. It begins with an assessment of your resources and your needs. The purpose of Life Care Planning is to improve the quality of life for the person for whom we are planning. Budgeting helps us understand what tools and resources we have to work in accomplishing that goal.
As you prepare your budget, there are several basic concepts you should consider. First, you should determine your needs, broken down on a monthly basis if possible. Consider everything from daily living expenses (rent, food, utilities) to recurring monthly fees (car payments, Netflix subscriptions) and other miscellaneous expenses (charitable donations, gifts, recreational activities). Don’t forget to include extraordinary emergency expenses that could catch you off guard (replacing a roof, unexpected healthcare expenses, etc) as well.
Then think: Is your monthly income sufficient to meet your needs and, if not, how will you supplement or enhance your income to meet your needs? Be realistic. Where possible, consider limiting certain risks by purchasing insurance. If you need professional help, speak with a Certified Financial Planner or someone else who has the skills to help you establish a budget.
Armed with this, we can help you move forward in drafting a Life Care Plan (and the appropriate Medicaid planning) that will give you the best life possible, without depleting your life savings or going into debt.
Create a budget by:
1. Naming categories that describe your expenses.
2. Estimate expenditures for each category. Use last year’s expenses as a guide.
3. Find areas where you can cut back.
4. Implement your budget, and stick to it.
5. Review and modify your budget at regular intervals.
Helpful Budgeting Links:
Making the decision to hire a home care service to provide care for your loved one is an important decision and can, at the same time, be very difficult. If an illness or recovery from surgery requires nursing care or physical therapy, a physician may order skilled home care services that provide both skilled providers and personal aides. Your decision is then based on the obvious medical determinations made by the doctor. But what if you as the family caregiver must determine the extent of care needed without the help of a doctor?
Each home care situation is unique. In the beginning, family or friends step in to help with simple tasks and support for aging seniors who want to stay in their homes. As long term care needs progress, more time is required to manage those needs. Physical and mental conditions change with aging making usually routine hygiene and daily living activities difficult for an aging individual. Even with the healthiest of seniors, the ability to drive a car, shop for groceries or do general housekeeping eventually needs to be relinquished to the responsibility of another person.
In one example, Karen, would stop by her parents’ home on her way to work every morning and again on her way home from work in the evening. She checked in the morning to see that they were up and ready for the day and Karen would take a shopping list for things they needed. In the evening she delivered the needed items she had purchased during her lunch break and sometimes she fixed a meal when one was not prepared by her mother. This worked well until Karen began to notice her father did not shave or dress during the day and both parents were forgetting their medications. Karen felt more time and supervision was needed in their care but with her own family and job, she could not do it. Non-medical or personal home care services would be a good option for Karen to consider.
Before starting your search for a non-medical or personal home care company, determine what the care needs are and how much time each week will be required for assistance from the company. You may want to consult with the family physician and other family members as well as experienced social workers or care managers to determine needs. Most home care companies, as well, will help you do an assessment at no charge. With your care needs in hand, you are ready to begin your search.
The National Association for Home Care & Hospice (http://www.nahc.org/home.html) gives the following guidelines and checklist in searching for a home care company.
- How long has this provider been serving the community?
- Does this provider supply literature explaining its services, eligibility requirements, fees, and funding sources? Many providers furnish their home care clients with a detailed “Patient Bill of Rights” that outlines the rights and responsibilities of the providers, clients, and family caregivers alike.
- How does this provider select and train its employees? Does it protect its workers with written personnel policies and malpractice insurance? Does it protect clients from theft or abuse by bonding its employees?
- Does this provider assign supervisors to oversee the quality of care clients are receiving in their homes? If so, how often do these individuals make visits? Who can the client and his or her family members call with questions or complaints? How does the company follow up on and resolve problems?
- What are the financial procedures of this provider? Does the provider furnish written statements explaining all of the costs and payment plan options associated with home care?
- What procedures does this provider have in place to handle emergencies? Are its caregivers available on notice?
- How does this provider ensure client confidentiality?
If a home care company has not previously been recommended to you, ask for a list of previous clients and call for their experience with this provider.
Following up on these guidelines can help you determine the quality of personal care that is given. Many states license non-medical home care companies and require both legal and health standards to be maintained.
Read about individual home care companies in your area on the National Care Planning Council’s website www.longtermcarelink.net. Photographer: photostock Evan H. Farr on Google +
The cost of growing old is a concept Baby Boomers are beginning to wrestle with as they contemplate long term care options for both themselves and their aging parents. But in today’s age of economic uncertainty and rising care costs, more dependent adults are relying on family members for care. The Wall Street Journal recently reported on a growing trend – compensating a relative to save money. In citing a report by the National Alliance for Caregiving and AARP, the WSJ pointed out that more than 43 million Americans cared for a friend or relative age 50 or older in 2009. This number has increased by more than 27% since 2004! But this strategy can have drastic consequences that must not be ignored.
Genworth Financial has posted a tool to view median care costs by state, plus future projected costs. Below are some key figures for the Commonwealth of Virginia:
If a family opts for relative-care, they must ensure that the relative can provide the assistance that is actually needed. Other important considerations include: Whether to pay the family member, how much to pay, and whether those facts should be disclosed to other family members. And of course, the person receiving the care should always be comfortable with their caretaker. The WSJ article referenced above suggests complete disclosure to the entire family, as a way to ease potential tension. Another important point – if Medicaid eligibility is a goal, there is no substitute to consulting an Elder Law Attorney. Medicaid laws may require a caregiver to be compensated in a specific way. One common misconception is that Medicaid is only available for the poor. To the contrary, Medicaid is available to anyone who can legally qualify. An Elder Law Attorney should be consulted for Medicaid asset protection planning, because as this article alluded to above, there are nuanced and complicated qualification rules.
Many of my clients ask me how I feel about reverse mortgages, and even more so this past week because of a favorable story that appeared in last week’s Washington Post entitled “Reverse Mortgages are Not the Next Subprime.” This excellent article was written by the ”Mortgage Professor,” a Professor of Finance Emeritus at the Wharton School of the University of Pennsylvania (incidentally, my Alma Mater), and clears up much of the confusion and myths and fears surrounding the reverse mortgage. I encourage all of you to read it. Another good source of information about reverse mortgages is the Federal Trade Commission Fact Sheet.
As a Certified Elder Law attorney, one of my primary goals is to help preserve the dignity and enhance the lives of my elderly clients. For many of my clients, remaining in their homes as long as possible is one of their highest priorities. I have been a long-time fan of reverse mortgages because they help my clients do exactly that — remain in their homes as long as possible.
Why? Because in order to remain in your home as long as possible, you will most likely at some point need some home care. “Home Care” can be health care and/or supportive care provided formally in your home by health care professionals (typically referred to as home health aides) or by paid or unpaid family members or friends (typically referred to as caregivers). Often, the term “home care” is used to mean non-medical care, or custodial care, which may be provided by persons who are not nurses, doctors, or other licensed medical personnel. The term “home health care” typically refers to care that is provided by a licensed health care professional — most often a Certified Nurse Assistant (CNA). However, the terms are often used interchangeably, and for simplicity in this article I will use the term “home care” to refer to both types of care.
The goal of home care is typically to to allow you to remain at home and age in place, rather than being forced to move to an assisted living facility or nursing home. Home Care providers render services in your own home. These services typically include a combination of health care services and life assistance services.
Health care services may include services such as wound care, administration of medication, physical therapy, speech therapy, and occupational therapy. Life assistance services typically include help with daily tasks such as meal preparation, medication reminders, laundry, light housekeeping, errands, shopping, transportation, companionship, and help with the activities of daily living (ADLs), which typically refers to six activities (bathing, dressing, transferring, using the toilet, eating, and walking).
Although some home care is provided by family members for free, most family caregivers need to be paid, and these payment arrangements should always be made pursuant to a written caregiver contract (prepared by an Elder Law Attorney) between the caregiver and the care recipient. Because home care is quite expensive, having the proceeds from a reverse mortgage is often one of the only ways that elders can afford to pay for appropriate home care. According to The 2009 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs, the 2009 national average hourly rate for home health aides increased by 5.0% from $20 in 2008 to $21 in 2009. The national average hourly rate for homemaker/companions increased by 5.6% from $18 in 2008 to $19 in 2009.
Most of my clients, when they start out needing home care, will typically start with receiving 4 hours of care 3 days a week, which costs about $1,000 per month and is easily affordable for many people. But over time, most of my clients progress to the point of needing upwards of 12 hours per day of home care, costing over $7,000 per month, and very few people can afford to pay for this type of care without eventually tapping into their home equity via a reverse mortgage.
The most common type of reverse mortgage is the Home Equity Conversion Mortgage (HECM), which completely protects your ability to remain in your home. So long as you pay your property taxes and homeowners insurance, and maintain your property, you can remain in your home forever. If the reverse mortgage lender fails, any unmet payment obligation to the borrower will be assumed by FHA.
According to the Mortgage Professor’s article mentioned in my first paragraph, in 2009 about 130,000 HECMs were written, and feedback from borrowers has been mostly positive. In a 2006 survey of borrowers by AARP, 93% said that their reverse mortgage had a mostly positive effect on their lives.
For many of my clients, a reverse mortgage is the best way, and often the only way, for them to be able to afford to remain at home, despite the fact that reverse mortgages are expensive to obtain. However, reverse mortgages are not for everyone, as there are other programs that may be able to help you remain in your home. For instance, many of my clients are eligible for the Veterans Aid and Attendance benefit or for home-based Medicaid, or can be made eligible for these benefits through our process of Asset Protection.
Whether you own your home outright or in a Revocable Living Trust or in my proprietary Living Trust PlusTM Asset Protection Trust, if you think a reverse mortgage might be the solution you need, please contact me for a free consultation so I can evaluate your specific situation and advise you as to whether a reverse mortgage is your best option for allowing you to live comfortably in your home.
Did you catch last Sunday’s Washington Post article by David Hilzenrath, about the October bankruptcy filing of Erickson Retirement Communities? My phone has been ringing all week with people concerned about this news, because Erickson is a major developer and manager of Continuing Care Retirement Communities (CCRCs) for senior citizens.
In the Washington area, Erickson communities include: Greenspring in Springfield, Virginia; Ashby Ponds in Ashburn, Virginia; and Riderwood in Silver Spring, Maryland. I spoke with the author prior to the article and gave him some of the information that he referenced in the article. As he explained, the recession and the real estate crisis have raised concerns for people who paid significant money — often hundreds of thousands of dollars — to enter CCRCs such as these.
It’s important to understand that the deposits that senior pay are simply for the privilege of moving in; at most CCRCs, the deposits generally do not confer any ownership in the real estate, and the deposits are in addition to the regular monthly fees for the facility, which increase as the level of care increases — from independent living up to assisted living and eventually nursing home care. Here’s a link for the article in case you missed it: http://tinyurl.com/EricksonBankruptcy.
In a companion article (http://tinyurl.com/ScrutinizeContracts), headlined Scrutinize any contract to avoid nasty surprises at continuing care community, the author points out that the entrance agreements for these facilities should always be reviewed by an attorney. “If you are considering moving to a continuing care retirement community,” the author says, “you would do well to consult a lawyer and read the fine print of any contract to determine whether the potential benefits outweigh the risks.” I have recommended this to my clients for years, and encourage everyone in the Northern Virginia area moving into a CCRC to have me review the contract. But please note — it is very important to have me review the contract prior to signing the contract. For many of the people calling me this week who read the article and are concerned, there’s nothing I can do because they already signed their contract. These folks I referred to a real estate litigation attorney to discuss the possible results of what might happen if they fail to go through with their contract. Those results could include being sued for breach of contract by the owner of the facility, and possibly being forced to pay significant monetary damages.
One risk in connection with the entrance contract is that most CCRC contracts require you to agree not to give away any assets that would bring your net worth below a minimum requirement (in order to help assure management that you have the ability to pay their ongoing charges). The author quotes me in article, saying “Evan H. Farr, a Fairfax lawyer who specializes in issues facing the elderly, recommends putting any extra assets in an asset protection trust before you move in.”
I’m very glad that the author included this quote in his article, because far too many people move into these types of facilities without giving asset protection a second thought. If you are considering moving into a CCRC, it behooves you to not just have me review the contract, but to also have me create the proper type of asset protection trust for you to put your extra assets in before you move in to the community. What is the proper type of asset protection trust? It’s my proprietary Living Trust PlusTM Asset Protection Trust — the trust that protects your assets from the expenses of probate PLUS lawsuits PLUS the catastrophic expenses of nursing home care.
As the creator of the Living Trust PlusTM and the leading expert on this type of trust in the country, I’ve taught thousands of attorney across the country about the benefits of these trusts, and I’m actually teaching another course on this subject to attorneys tomorrow at an annual conference of the National Academy of Elder Law Attorneys. If you want to find out more about the Living Trust PlusTM, please come to a free class I’m teaching for members of the public on Saturday, November 14, 2009 at 10:00:00 AM, at the Tysons Corner Mariott, 1960-A Chain Bridge Road, McLean, VA 22012.
By coming to this FREE class, you’ll learn what thousands of attorneys and clients already know . . .
- That a Will puts your assets through probate, and is a very poor estate planning document.
- That a regular living trust protects your assets from probate, but offers you no asset protection.
- That my Living Trust PlusTM Asset Protection Trust protects your assets from the expenses of probate PLUS lawsuits PLUS the catastrophic expenses of nursing home care.
To register, just go to http://evanfarr.com/seminars.html.
I hope to see you soon!