Most nursing home admissions happen under extremely stressful circumstances. If you are faced with the overwhelming task of finding the best nursing home placement for a loved one, where do you begin? Although this is a job that no one wants, it can be done with forethought and confidence that the best decision was made for everyone involved.  It’s easier, and better for your loved one, if the first placement is well thought out. Although a nursing home resident can be moved from one facility to another, this type of disruption can be very disturbing and is rarely in everyone’s best interest.

The federal Center for Medicare & Medicaid Services (CMS) has a part of its Web site – Nursing Home Compare — comparing nursing homes, which identifies facilities that have a history of poor performance. The Nursing Home Compare site labels nursing homes it calls Special Focus Facilities — those that have repeatedly violated state and federal health and safety rules and that rank in the worst 5 to 10 percent of all inspected facilities in a given state.  Using Nursing Home Compare, you can obtain detailed inspection information about each nursing facility that interests you, comparing various government-rated “quality measures” such as:

• Percent of Residents Who Have Moderate to Severe Pain;
• Percent of High-Risk Residents Who Have Pressure Sores;
• Percent of Residents Who Were Physically Restrained; and
• Percent of Residents Who Spend Most of Their Time in Bed or in a Chair.

The Nursing Home Compare Web site also rates the care and services that each facility provides to its residents, and allows you to view how each facility stacks up in staffing hours for each type of health care worker against the state and national averages.

U.S. News and World Report also recently started providing rankings of America’s nursing homes. The U.S. News rankings rely on Nursing Home Compare but provide some advanced search engine capability.   According to U.S. News,  their new feature –America’s Best Nursing Homes – addresses these and other issues.  Nursing homes are presented in tiers within each star category, based on their total stars in all three of the major areas. The topmost tier, for example, consists only of five-star homes that got 15 stars. The next tier down is five-star homes with 14 total stars, and so on. Within each tier, nursing homes are listed alphabetically. If you’re looking for a nursing home by location, and turn up too many, search terms can be combined in order to narrow the results.  For example, perhaps you want to search just for nursing homes that have a religious affiliation, or that accept Medicaid residents. Or you can launch a multipronged search, perhaps searching for non-profit four-star nursing homes that accept Medicaid and are located within 25 miles of a particular city. 

Placing your loved one in a nursing home that accepts Medicaid is vitally important if you plan to use the services of an Elder Law firm  (such as the Farr Law Firm) to help you with Medicaid Asset Protection.

Another free Web site that lets you compare nursing homes is MemberoftheFamily.net, which features easy-to-read, color-coded assessments of nursing homes nationwide.

Despite the ratings, in my experience nothing can substitute for visiting a nursing home in person. Virtually every nursing home will
have some deficiencies; after all, working with extremely disabled and impaired persons is very difficult. In my book, The Virginia Nursing Home Survival Guide (available as a free e-book on our Web site or in print edition at Amazon.com), I provide a Nursing Home Evaluation Tool to help consumers compare nursing homes during personal visits.

To find the best possible nursing home for your family’s situation, the first step is to determine what is most important for your family in looking for a facility. The resident’s needs and desires must be included in this evaluation. Consider variables such as location of the facility, whether a special care unit (such as for dementia) is available, and what types of payment sources are accepted. 

The second step is to identify the facilities in your area which meet the criteria you have established.

Step three is to tour those facilities you have identified in step two.  You don’t need to schedule your visits in advance. If you show up during regular business hours, you should be able to meet with an administrative staff member, who should be able to answer all your questions.  You will also want to tour a second time, in the evening or on the weekend, to see if there is a drastic difference in the atmosphere of the facility or the care being provided. It is important to tour at least two facilities so you can see the difference in the physical facility and the staff. 

While you are touring the facility, pay attention to your gut feelings.  Ask yourself:

• Do I feel welcome?
• How long did I have to wait to meet with someone?
• Did the admissions director ask about my family member’s wants and needs?
• Is the facility clean?
• Are there any strong odors?
• Is the staff friendly?
• Do they seem to genuinely care for the residents?
• Do the staff seem to get along with each other?

Listen and observe. You can learn a lot just by watching and paying attention. And ask questions. You want to be sure that the facility is giving proactive care, not just reacting to crisis.  Here are a few examples of the types of questions the staff should be able to answer:

• How do you ensure that call lights are answered promptly, regardless of your staffing?
• If my father is not able to move or turn himself, how do you ensure that he is turned and does not develop bedsores?
• How do you make sure that someone is assisted with the activities of daily living like dressing, toileting and transferring?
• Can residents bring in their own supplies?
• Can residents use any pharmacy they wish?
• How many direct care staff members do you have on each shift? Does this number exceed the minimal number that state regulations require, or do you just meet the minimum standard?
• What sources of payment do you accept?
• How long has the medical director been with your facility?
• What is your policy on family care planning conferences? Will you adjust your schedule to make sure that I can attend the meeting?

While touring each facility, use my Nursing Home Evaluation Tool to help you keep track of which facility you like best.  

Don’t Forget Expert Legal Help.

In addition to finding the facility you like best, don’t forget that you need expert legal assistance as part of the nursing home planning process. Without proper planning and legal advice from an experienced Elder Law firm such as the Farr Law Firm, many families needlessly squander their life savings on long-term care, and unnecessarily jeopardize their own care and well-being, as well as the security of their family.   The way to get the best care in any nursing home is to make sure that you choose a nursing home that accepts Medicaid and work with a Certified Elder Law attorney who specializes in Medicaid Asset Protection.  

What is the goal of this type of planning? The goals differ from person to person and family to family. Generally, for a married couple the most important goal is to ensure that the spouse remaining at home is able to live the remaining years of his or her life in utmost dignity, without having to suffer a drastic reduction in his or her standard of living. For a single or widowed client, the most important goal is typically to be able to enjoy the highest quality of life possible in the event of an extended nursing home stay. When there is an adult child or grandchild who is disabled, the primary goal is typically to protect assets to be used for the benefit of that disabled family member who is often also receiving Medicaid.  Money that is protected through proper planning can be used to provide a nursing home resident with an enhanced level of care and a better quality of life while in a nursing home and receiving Medicaid benefits.

For instance, protected assets can be used to hire a private nurse or a private health aide — someone to provide one-on-one care to the
resident — to help the resident get dressed, to help the resident get to the bathroom, to help the resident at mealtime, and to act as the
resident’s eyes, ears and advocate.  Money that is sheltered through proper planning can also be used to purchase things for the nursing home resident or disabled child that are not covered by Medicaid — such as special medical devices, upgraded wheel chairs, transportation services, trips to the beauty salon, etc.

Lastly, some parents do have a strong desire to leave a financial legacy for their children, particularly if there is a disabled child or
someone who needs special financial help.  

The Farr Law Firm specializes in Medicaid Asset Protection.  When your family member needs nursing home care, please remember that we are here to help you.

Did you elect to take Social Security benefits before your full retirement age? If you did and are now looking for extra income, there may be an answer. Once you reach full retirement age, you can pay back the money you have received and reapply for full retirement benefits.Although you can collect Social Security benefits between age 62 and your full retirement age, if you do, your benefits will be lower. For example, if you were born in 1944 and decide to retire and start collecting social security benefits at age 62, four years before your full retirement age of 66, your total benefit reduction is 25 percent. If your full benefit was to be $1,000 a month, your reduced benefit will be $750.

A little-known provision of Social Security allows you to withdraw your application for early benefits and reapply for your full benefits. The catch is that you must be able to pay back all the money you received so far. However, because you do not have to pay any interest on the benefits you received, if you can find the money to repay the benefits, it may be worth it. You could think of it as an interest-free loan.

If this is something you’re interested in exploring, you should contact your financial advisor and/or your CPA to determine if this option might make sense for your specific situation.

An 88-year-old California widow is challenging an attempt by her continuing care retirement community (CCRC) to move her from her private apartment to an assisted living unit. If she is successful, the outcome could set a legal precedent for more than 5 million Americans living in retirement communities, CCRCs, and assisted living facilities.

In 1991, Sally Herriot and her husband, John, paid a $180,000 non-refundable entrance fee to Channing House, a Palo Alto that offers residents a continuum of care, from independent living to skilled nursing units. As is typical of CCRC contracts, the Herriot’s admission agreement gave Channing House’s administrators the right to determine the appropriate level of care for the couple and the authority to move either of them into an assisted living unit or a skilled nursing facility if and when it determined they needed more care.

Mr. Herriot died in 2005. Last year, Channing House notified Mrs. Herriot — who uses a walker, needs help getting dressed and has problems with her eyes — of their intention to move her from her spacious ninth-floor apartment with a covered balcony to a much smaller, hospital-like assisted-living unit where she would share a room but also be served by a trained nursing staff. Mrs. Herriot resisted, saying that with the help of the round-the-clock private aides she hires herself, she has everything she needs and does not require a higher level of care.

Mrs. Herriot’s attorneys, Michael Allen and Susan Silverstein (who is with AARP), filed a lawsuit alleging that by forcing Mrs. Herriot to move, Channing House is violating anti-discrimination housing and disability laws. Channing House’s executive director, Carl Braginsky, counters that decisions to move residents from one level of care to another are made only after careful consideration and consultation with medical staff. Paul Gordon, one of Channing House’s attorneys, rejected as “insulting and misleading” Mrs. Herriot’s attorneys’ assertions that such decisions are motivated by the opportunity for financial gain, such as from the sale of Mrs. Herriot’s now greatly-appreciated apartment.

The result of the case could have lasting repercussions on how America’s burgeoning population of seniors is allowed to age. “If Sally Herriot can be forced to move, then it undermines the whole concept of aging in place,” her attorney Michael Allen told the San Francisco Chronicle.

Lawyers on both sides are scheduled to begin mediation in April, and considering that CCRCs are in the business of marketing peace of mind, Channing House may have additional incentives to avoid a trial.

For those wishing to make charitable donations from their IRA accounts, dealing with the resulting tax issues just got a lot easier. In August, Congress passed, and President Bush signed, the Pension Protection Act of 2006. Touted as the most significant overhaul of the pension system in the past 30 years, one provision of the law changes how charitable donations are taxed.

Previously, those wishing to make charitable donations using money in their IRA accounts were required to withdraw funds from their IRA and pay income tax on the withdrawal before they could take a charitable donation deduction on their annual tax returns. But under the new law, so long as the donation is transferred directly from an IRA or rollover IRA account to an eligible public charity, the donor doesn’t have to pay any income tax on the withdrawal at all. As far as the federal government is concerned, money donated to the charity simply is not income. (But note that the transfer is no longer eligible for the charitable tax deduction, either.)

It remains to be seen, however, whether such withdrawals for charitable purposes will count toward an individual’s minimum IRA distribution requirements for the year. If the qualifying donations do not count toward the distribution amounts, then donors will be required to withdraw more funds from their IRA accounts, and these funds will be subject to income tax. Unfortunately, the law is not clear on this issue.

Other requirements of the new charitable donation rule are clearer. They include:

- The donor must be 70 ½ years old.
- There is a $100,000 annual limit on donations.
- The donations may only be made from an IRA or rollover IRA account. Donations from other   retirement accounts, such as a 401(k), do not qualify.
- The organization receiving the donation must be a qualifying public charity. Donations to private foundations, supporting organizations, trusts established for both charitable and non-charitable purposes, or other funds over which the donor may have some advisory control do not qualify.
- The transfer must be made directly from the IRA account to the qualifying organization. This is ordinarily done by instructing the brokerage firm holding the IRA to make the transfer. If the donor receives the funds from the IRA and then donates them to charity, they will be subject to the income tax.

IRA holders can take advantage of the charitable donations provision until it expires on December 31, 2007.