Estate Planning Blog Articles

Estate & Business Planning Law Firm Serving the Providence & Cranston, RI Areas

Tips on Finding the Right In-Home Aide

About 90% of older adults would prefer to age in place, rather than move into an assisted living facility or nursing home, according to an AARP survey.

WRAL’s recent article entitled “How to choose an in-home health aide” says that, fortunately, you can have good health care and independent living with an in-home health aide. An aide can provide you with care for a short amount of time during the day or can stay with you around the clock. Depending on your needs, an aide can help with many tasks. These include things such as:

  • Chores, such as laundry, cooking and shopping
  • Daily activities, such as bathing, dressing, eating, grooming, moving from one place to another and toileting
  • Monitoring vital signs, like blood pressure, respiration, and pulse
  • Keep an eye on your physical and mental health, including your level of exercise and how much you are eating, drinking, and going to the bathroom; and
  • Assist in emergencies, like an accident, heart attack, or stroke.

There are a number of actions to take when you hire an in-home health aide. Here’s the rundown:

  1. Determine what kind of care, and how much, you need.
  2. Decide if you want to hire through an agency or on your own. The advantages of using an agency are that you will get a prescreened aide and will have backup care when that person is unavailable. You also won’t have to be concerned about offering benefits as an employer because the agency takes care of those.
  3. Consider what you can afford. If you qualify for Medicare or have long-term care insurance, some or all your care may be paid for. If you use an agency, the Mayo Clinic suggests you ask for written, detailed explanations of all services and fees associated with home care. Once you have this from several agencies, you’ll be able to choose the best one for your budget. If you hire a home health aide yourself, remember to think about sick days, holidays, vacation, payroll taxes and Social Security. That is because your aide will be considered a household employee.
  4. After you’ve found your health aide, create a care plan, which may include the following:
  • The days and hours you need assistance
  • The daily tasks that need to be completed
  • A schedule of appointments and medication times
  • A list of contacts, such as your doctor’s information
  • An emergency plan; as well as
  • Any of your personal preferences.

Re-evaluate your care plan every few months. Ask your family to discuss this with you because having loved ones on board will be helpful in the future, when you may need more support as you continue to age in place.

Reference: WRAL (April 17, 2022) “How to choose an in-home health aide”

Medicare’s Coverage of New Controversial and Expensive Alzheimer’s Drug Is Limited

The final decision, which comes after a proposed policy released in January, will have significant consequences for millions of Alzheimer’s patients and tens of millions of Medicare enrollees. It’s the latest step in the drug’s contentious path to market, reports CNN’s recent article entitled “Medicare limits coverage of controversial Alzheimer’s drug to those in clinical trials.”

The policy is expected to restrict the number of people who can receive the medication. This coverage policy would also apply to other drugs in this class, such as monoclonal antibodies that target amyloid, or plaque, for the treatment of Alzheimer’s disease, that the FDA may approve in the future.

Biogen, the maker of Aduhelm, called CMS’ decision unprecedented and said it will deny all Medicare enrollees access to the drug and may limit coverage for treatments approved in the future.

“When additional data from this new class of treatments become available, Biogen urges CMS to reconsider today’s decision for all FDA-approved amyloid-beta targeting therapies,” the company said in a statement, noting that it is considering its options.

The CMS made this decision based on evidence and analysis of public feedback, CMS Administrator Chiquita Brooks-LaSure said in a statement. More than 10,000 comments on the proposed policy were submitted.

“CMS has a responsibility to ensure that people with Medicare have equitable and appropriate access to therapies that are reasonable and necessary for use in the Medicare population,” she said. “Through this decision, we are creating a pathway for people with Medicare to quickly access drugs the FDA determines have shown a clinical benefit and encourages manufacturers and trial administrators to ensure that the clinical trials recruit racially diverse participants.”

The agency examined the potential for patient benefits against the significance of serious unknown factors that could result in harm, Dr. Lee Fleisher, CMS chief medical officer, said in a statement.

“There is the potential for promise with this treatment; however, there is not currently enough evidence of demonstrating improved health outcomes to say that it is reasonable and necessary for people with Medicare, which is a key consideration for CMS when making national coverage determinations,” Fleisher said.

CNN says that Medicare has never required enrollees to participate in a clinical trial for a drug already approved by the FDA that is being used for its intended purpose.

The FDA’s approval of Aduhelm last June brought about questions and concerns about the process, the drug’s efficacy, as well as its annual cost. Biogen initially priced it at about $56,000 a year. The approval was also a big motivator for a huge increase in Medicare Part B premiums for 2022. The standard monthly payment increased to $170.10, up from $148.50 last year, for the more than 63 million enrollees.

Roughly $10 of the premium spike is due to Aduhelm, a CMS official told CNN. The remainder is from a general increase in health care prices and usage, as well as from congressional action that limited the rise in Part B premiums for 2021 amid the coronavirus pandemic.

Reference: CNN (April 7,  2022) “Medicare limits coverage of controversial Alzheimer’s drug to those in clinical trials”

What Do I Need to ‘Age in Place’?

Home modification is the official term (from the Americans with Disabilities Act) for renovations and remodels aimed for use by the elderly or the impaired. It means physically changing your home, removing potential hazards and making it more accessible, so you can continue living in it independently.

Bankrate’s recent article entitled “The best home modifications for aging in place” reports that home modifications can be pricey—typically ranging from $3,000 to $15,000, with the average national spend being $9,500. However, it can be a worthwhile investment. You can save money by doing the right home modifications. That is because the longer you can safely live in your home, the less you will need to pay for assisted living care.

The best aging-in-place home modifications align with “universal design,” an architectural term for features that are easy for all to use and adaptable, as needs dictate. This includes additions and changes to the exterior and interior of a home. Some of the simplest home modifications include DIY jobs:

  • Adding easy-grip knobs and pulls, swapping knobs for levers
  • Installing adjustable handheld shower heads
  • Rearranging furniture for better movement
  • Removing trip hazards; and
  • Installing mats and non-slip floor coverings.

Next, are some more complex home modifications. These probably would need a professional contractor, especially if you want them up to code standards:

  • Installing handrails
  • Adding automatic outdoor lighting
  • Installing automatic push-button doors
  • Leveling flooring; and
  • Installing doorway ramps

There are also home modifications that can be done by room:

  • In the bathroom, installing grab bars and railing, a roll- or walk-in shower/tub, or a shower bench
  • In the kitchen: adding higher countertops, lever or touchless faucets and cabinet pull-out shelves
  • For the bedroom, use a less-high bed, non-slip floor, walk-in closets and motion-activated lights
  • Outside, you can add ramps, a porch or stair lifts, and automatic push button doors.

Finally, throughout the house, keep things well-lit and widen hallways and doorways; add a first-level master suite, elevators or chair lifts, “smart” window shades/thermostats/lighting and simpler windows.

Note that some home modifications may qualify as medical expenses. As a result, they are eligible for an itemized deduction on your income tax return. A home modification may be tax-deductible as a medical expense, if it has made to accommodate the disabilities (preferably documented by a physician or other health care provider) of someone who lives in the home, according to the IRS.

Reference: Bankrate (March 30, 2022) “The best home modifications for aging in place”

Can I Avoid the Economic Dangers of Caregiving?

AARP’s recent article entitled “5 Steps to Avoid Economic Pitfalls of Caregiving” reports that 20% of family caregivers have to take unpaid time off from work due to their caregiving responsibilities.

The average lifetime cost to caregivers in lost wages and reduced pension and Social Security benefits is $304,000 — that is $388,000 in today’s dollars. This does not count the more than $7,200 that most caregivers spend out of pocket each year, on average, on housing, health care and other needs for loved ones in their care, according to the AARP report.

Step 1: Calculate the gap. The average cost of a full-time home health aide is nearly $62,000 a year, and a semiprivate room in a nursing home runs about $95,000. Ask your parents about the size of their nest egg, how fast they are spending it, whether they have long-term care insurance and how much equity they have in their home. Compare your parents’ assets against their projected expenses to determine your gap.

Step 2: Fill the gap without going broke. Try to find free resources: Use the National Council on Aging’s BenefitsCheckUp tool to find federal, state and private benefit programs that apply to your situation. Then create a budget to determine what you can contribute, physically and in dollars, to closing the gap. In addition, ask your siblings if they can pitch in.

Step 3: If a gap remains, consider Medicaid. This program can cover long-term care. However, your parent or parents may need to spend down assets to qualify. Note that if just only one parent is in a nursing home, the other can generally keep half of the assets, up to a total of $137,400 (not including their house). However, the rules differ by state. As a result, this can get complicated. Speak with an elder-law attorney for help.

Step 4: No matter what the gap, try to get paid. If your parents have enough resources, you may discuss having them pay you for caregiving. However, you should speak with an attorney first about drawing up a contract. This should include issues like the number of hours a day you will spend on providing care and whether doing so will require you to quit your job. The caregiving agreement is written carefully, so that it does not violate Medicaid regulations about spending down assets.

Step 5: Protect your own earning ability. If you are mid-career, it is very difficult to leave a job for ​family responsibilities like caregiving and then go back into the workforce at the same salary. The Society for Human Resource Management says that it costs six to nine months’ salary to replace an employee, so many employers now see it is less expensive to make an accommodation.

Reference: AARP (Feb. 24, 2022) “5 Steps to Avoid Economic Pitfalls of Caregiving”

Assisted Living Providers Face More Pandemic-Related Scrutiny from OSHA

The U.S. Department of Labor announced this week that the Occupational Safety and Health Administration (OSHA) is beginning a time-limited enforcement effort for focused inspections in assisted living communities, nursing facilities, and hospitals treating people with COVID-19.

McKnight’s Senior Living’s recent article entitled “Assisted living providers to face additional pandemic-related scrutiny from OSHA” reports that the inspections are limited to organizations with previous COVID-19-related citations or complaints. They will look at the correction of the citations and compliance with existing OSHA standards to stress monitoring for current and future readiness.

OSHA explained that its goal is to expand its presence to ensure continued mitigation efforts to control the spread of COVID-19 and future variants, and to protect the health and safety of healthcare workers “at heightened risk for contracting the virus.”

OSHA will devote 15% of all of its inspections to healthcare organizations in the following classifications: assisted living facilities for the elderly, nursing care / skilled nursing facilities, psychiatric and substance abuse hospitals and general medical and surgical hospitals.

“We are using available tools while we finalize a healthcare standard,” Assistant Secretary of Labor for Occupational Safety and Health Dough Parker said. “We want to be ahead of any future events in healthcare.”

This strong effort in pandemic-related scrutiny may be a temporary action until OSHA finalizes an anticipated permanent infectious disease standard for the healthcare industry. OSHA withdrew the non-recordkeeping part of its healthcare emergency temporary standard in December. However, they said it would “work expeditiously to issue a final standard.” The agency said it would accept continued compliance with the healthcare ETS as satisfying employers’ obligations under OSHA’s general duty clause.

OSHA adopted its COVID-19 healthcare ETS in June. This required assisted living communities and other healthcare settings to conduct hazard assessments and have written plans in place to mitigate the spread of the coronavirus. These rules also required healthcare employers to provide some employees with N95 respirators and other personal protective equipment. The standard also included social distancing, employee screening and cleaning and disinfecting protocols.

While OSHA highlights skilled nursing facilities and hospitals in its memorandum for regional administrators, assisted living facilities also are mentioned.

At least 20 states have their own OSHA-approved state plans and may proceed differently than those subject to federal OSHA standards. However, the agency recommended that all healthcare employers in high-risk settings be ready for inspection. Healthcare employers should also have COVID-19 procedures and protocols in place and review their procedures for managing OSHA inspections.

Reference: McKnight’s Senior Living (March 10, 2022) “Assisted living providers to face additional pandemic-related scrutiny from OSHA”

What Is Virginia Doing to Protect the Residents of Assisted Living Communities?

The eviction bill is sponsored by Virginia state senators Lionell Spruill (D) and Ghazala Hashmi (D). The legislation would amend the Virginia code to give assisted living residents the same protections as nursing home residents facing eviction, reports McKnight’s Senior Living’s recent article entitled “Assisted living providers may face new requirements before evicting residents.”

Susan Rowland, Spruill’s chief of staff, told the McKnight’s Business Daily that the legislation is meant to close a loophole in Virginia law that lets assisted living communities evict residents with no legal recourse.

If SB40 becomes law, assisted residents would be provided with certain safeguards from being involuntarily discharged. These include requiring operators to provide a description of the reasons for eviction, such as that the facility no longer can meet the resident’s care needs, behavioral issues or non-payment. Facilities would also need to make reasonable efforts to resolve any issues leading up to the eviction. Residents would need to be given 30 days’ notice before evictions and also be notified of their right to appeal the involuntary discharge.

In addition, according to the legislation, “Prior to involuntarily discharging a resident, the assisted living facility shall provide relocation assistance to the resident and the resident’s representative, including information regarding alternative placement options.”

Amy Hewett, vice president of strategy and communications for the Virginia Health Care Association / Virginia Center for Assisted Living, remarked that the association “appreciated the opportunity to work with the bill patron Sen. Lionell Spruill and advocates to take steps toward ensuring that both residents and providers have an understanding of the involuntary discharge process.”

Dana Parsons, vice president and legislative counsel for LeadingAge Virginia, said the organization “believe[s] this legislation is a positive step forward and will provide housing protections as well as stability and positive support to aging Virginians.”

Assisted living communities in the commonwealth are deemed non-medical in nature. As a result, they are not subject to the same regulations as skilled nursing facilities. Assisted living residents also are not covered by the commonwealth’s Landlord and Tenant Act. Geriatric homes are specifically excluded from eviction protections afforded other renters, “as these tenancies and occupancies are not residential tenancies under this chapter.”

Residents evicted from the state’s assisted living communities could only go to the Office of the State Long-Term Care Ombudsman, which could attempt to mediate disputes. However, there was no requirement for assisted living communities to cooperate.

Reference: McKnight’s Senior Living (March 10, 2022) “Assisted living providers may face new requirements before evicting residents”

Suggested Key Terms: Elder Law Attorney, Assisted Living

Is Advance Care Planning a Benefit to Seniors?

Advance care planning (ACP) is an ongoing discussion that involves shared decision-making to clarify and document an individual’s wishes, preferences and goals regarding their medical care. This is extremely important to making certain that they get the medical care they want, if they become incapacitated and unable to make their own decisions. Despite the importance of ACP, most Americans don’t have their medical wishes documented, according to Medical Life Sciences News’ recent article entitled “Comprehensive approach may promote Advance Care Planning for elderly adults.”

In the pandemic, too many families exhausted themselves attempting to address this issue, agonizing over what their loved one might have chosen for their care if they had been given the chance.

Dr. Angelo Volandes, MD, MPH, physician and researcher, Division of General Internal Medicine at Massachusetts General Hospital, and colleagues started the Advance Care Planning: Communicating with Outpatients for Vital Informed Decisions (ACP-COVID) pragmatic trial. This experiment was designed to see if ACP participation during the pandemic would increase following implementation of video decision aids and clinician communication skills training. They also looked at how these interventions would affect ACP documentation among patients from ethnic and racial minority groups, specifically African Americans and Hispanics.

The trial included a large, diverse patient population aged 65+ from 22 outpatient clinics at Northwell Health, the largest healthcare system in New York State. ACP documentation from three six-month time periods was compared:

  1. Pre-COVID-19
  2. The first wave of COVID-19; and
  3. An intervention period.

The findings showed that ACP documentation was significantly greater among all groups during the intervention period, with African American and Hispanic patients showing the most significant increases.

“The stark disparity in COVID-related outcomes for African American and Hispanic patients highlights a reality already known by many: our healthcare system routinely fails to meet the needs of minority patients. No one intervention or initiative is going to correct all those failings though advance care planning, through engaging and empowering patients, is one of the most effective, immediate ways to address disparities in care,” adds Volandes, who is also an Associate Professor of Medicine at Harvard Medical School.

“Fundamentally, advance care planning aims to empower patients. The results of our study demonstrate the importance of meeting patients where they are,” adds Volandes. “Whether that means providing information in their native language or sharing educational material via text rather than a patient portal, if advance care planning is to be about the patient and we need to find ways to ensure that they feel they have the knowledge and ability to make decisions alongside their clinicians when they deem the time is right. COVID-19 has made ACP more important than ever, and especially in communities that have been hardest hit by the pandemic.”

Reference: Medical Life Sciences News (Feb. 28, 2022) “Comprehensive approach may promote Advance Care Planning for elderly adults”

Must I Sell Parent’s Home if They Move to a Nursing Facility?

If a parent is transferring to a nursing home, you may ask if her home must be sold.

It is common in a parent’s later years to have the parent and an adult child on the deed, with a line of credit on the house. As a result, there’s very little equity.

Seniors Matter’s recent article entitled “If my mom moves to a nursing home, does her home need to be sold?” says that if your mother has assets in her name, but not enough resources to pay for an extended nursing home stay, this can add another level of complexity.

If your mother has long-term care insurance or a life insurance policy with a nursing home rider, these can help cover the costs.

However, if your mom will rely on state aid, through Medicaid, she will need to qualify for coverage based on her income and assets.

Medicaid income and asset limits are low—and vary by state. Homes are usually excluded from the asset limits for qualification purposes. That is because most states’ Medicaid programs will not count a nursing home resident’s home as an asset when calculating an applicant’s eligibility for Medicaid, provided the resident intends to return home

However, a home may come into play later on because states eventually attempt to recover their costs of providing care. If a parent stays a year-and-a-half in a nursing home—the typical stay for women— when her home is sold, the state will make a claim for a share of the home’s sales proceeds.

Many seniors use an irrevocable trust to avoid this “asset recovery.”

Trusts can be expensive to create and require the help of an experienced elder law attorney. As a result, in some cases, this may not be an option. If there’s not enough equity left after the sale, some states also pursue other assets, such as bank accounts, to satisfy their nursing home expense claims.

An adult child selling the home right before the parent goes into a nursing home would also not avoid the state trying to recover its costs. This because Medicaid has a look-back period for asset transfers occurring within five years.

There are some exceptions. For example, if an adult child lived with their parent in the house as her caregiver prior to her being placed in a nursing home. However, there are other requirements.

Talk to elder law attorney on the best way to go, based on state law and other specific factors.

Reference: Seniors Matter (Feb. 25, 2022) “If my mom moves to a nursing home, does her home need to be sold?”

What Did I Hear about Over-the-Counter Hearing Aids?

The proposed rule comes four years after Congress passed a law mandating that the FDA to establish a category of over-the-counter hearing aids. The agency ran through its August 2020 deadline for doing so, but now has finalized it after a 90-day public commentary period. The FDA’s updated guidelines will create a new category of devices requiring neither a prescription nor a fitting by an audiologist. These will be sold online and at retail stores for adults with mild to moderate hearing loss.

AARP’s recent article entitled “FDA Clears Way for Over-the-Counter Hearing Aids” reports that right now those seeking hearing aids usually must see a health care professional for testing and fitting — a process that can be both costly and lengthy.

“Hearing loss has a profound impact on daily communication, social interaction and the overall health and quality of life for millions of Americans,” Acting FDA Commissioner Janet Woodcock, M.D., said in a statement. “The FDA’s proposed rule represents a significant step toward helping ensure that adults with mild to moderate hearing loss have improved access to more affordable and innovative product options.”

About 15% of U.S. adults (37.5 million) report trouble hearing, according to the National Institute on Deafness and Other Communication Disorders, and fewer than 1 in 3 adults aged 70 and older with hearing loss who could benefit from hearing aids have ever used them. The reason most often cited is the cost. Hearing aids currently cost between $2,000 and $6,000 a pair and are not covered by Medicare or most insurance. The proposed rule is expected to lead to lower prices for consumers, by lowering barriers to entry for hearing aid makers.

The only over-the-counter options now available have been personal sound-amplification products (PSAPs), which increase the volume of all the sounds in a given environment, and which typically cost a hundred dollars a pair.

“Reducing health care costs for everyone in America is a top priority,” Health and Human Services Secretary Xavier Becerra said in a statement. “Today’s move by FDA takes us one step closer to the goal of making hearing aids more accessible and affordable for the tens of millions of people who experience mild to moderate hearing loss.”

Reference: AARP (Oct. 19, 2021) “FDA Clears Way for Over-the-Counter Hearing Aids”

How to Maintain Mobility while Getting Older

About 27.5% of people globally do not get enough physical activity, according to a 2018 study in The Lancet Global Health of nearly two million people.

Sufficient physical activity was defined as at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity per week.

Livestrong’s recent article entitled “Why Your Mobility Worsens As You Age, and What to Do About It” examines the habits that experts want you to apply:

  1. Remain Active. Try to build activity into your day and keep moving. One of the simplest and best exercises is walking. Start small and work up to longer sessions, until you reach 30 minutes a day. If you do not have the time for a full walk some days, do what you can because every bit counts.
  2. Mix Up Your Moves. While it is great to find a workout you like, doing the exact same exercises every day is not ideal for joint mobility. It is better to do exercise sessions that look different on different days of the week. You can and should repeat your workouts from week to week. Experts say a combination of activities, such as strength training, cycling, running and yoga, will move your joints in all the ways possible.
  3. Take Standing Breaks. If you have a desk job, you are spending a lot of time at your desk. A way to counteract being sedentary at your desk is to move frequently. If you are at a desk job, you can stand up on your feet and/or walk once an hour for five minutes. This sitting engages large skeletal muscles and, when consistently performed throughout the day, activates thousands of muscular contractions, the researchers note. Standing up more — no matter your age — is important, even if you have done a workout that day.
  4. Stretch! Stretching that targets your shoulders, spine, hips, and calves can fight chronic stiffness that plays into mobility losses in older adults. Stretching — both with static (bend and hold) stretches as well as dynamic (flowy) ones — is a super opportunity to move your joints in ways they otherwise might not all too regularly. Many yoga workouts also include a flexibility and mobility component.

However you decide to bend and stretch, concentrate on challenging yourself, but do this without pain.

Pushing yourself too hard into stretches may damage your joints and contribute to injury.

Remember that the goal is to feel a gentle, pleasant stretch in your muscles. If it does not feel good, listen to your body and pull back a bit or totally avoid that stretch.

Reference: Livestrong (Jan. 20, 2022) “Why Your Mobility Worsens As You Age, and What to Do About It”

Join Our eNewsletter

Recent Posts
Categories