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Estate Planning Tips for Solo Seniors

The people who typically think the most about estate planning are those in a traditional nuclear family unit, with spouses, adult children, grandchildren and a clear idea of how they want to pass along assets and who can be trusted to carry out their wishes. It’s easier to plan ahead, reports a recent article titled “Elder Care: Estate planning when you are on your own” from The Sentinel, when the right person to put in charge is easy to identify.

When more and more families do not fall into the traditional nuclear family unit, how should they proceed with estate planning?

This can be a challenging scenario, especially if the person is not married and has no children. It’s hard to know who to name for important roles, like who will take charge if the person becomes ill or dies.

Some single people may think it doesn’t matter, because they don’t care about who inherits their possessions. However, estate planning is not just about distributing property. Planning for incapacity may be the most important part of estate planning—making legally enforceable decisions about medical care, end-of-life care and managing the business aspect of your life if you are incapacitated.

Two of the most important documents for a person who cannot speak for themselves are a Financial Power of Attorney and a Health Care Power of Attorney. These are the critical documents giving the person you designate the ability to manage your affairs and be involved in your medical care.

Without them, someone will need to take over for you. Who will it be? The process begins in the court, with a legal proceeding called guardianship. There are any number of reasons to avoid this. First, it takes a long time and any actions or decisions requiring a legal guardian will not be made with any speed. Second, guardianships are expensive. The process of having a guardian named and the fees paid to the guardian will be paid by you, whether you are conscious or not. While many people who act as guardians for others are trustworthy and kind-hearted, there are many horror stories—including several true stories made into movies—where guardians are more focused on enriching themselves than their ward’s best interests.

Guardianship can be easily avoided. Meeting with an estate planning attorney to prepare your last will and testament, Power of Attorney and Power of Health Care Attorney gives you control over who will be in charge of your life if you are incapacitated. Having these documents properly prepared by an experienced estate planning attorney ensures that you can be admitted to a hospital or facility offering the care you need, your bills will be paid and if your situation requires filing for long-term care benefits or disability, someone can do it for you.

If you don’t have a spouse or children, you probably have a healthy network of friends and extended family members you trust and are your “family by choice.” If you don’t feel these people are trustworthy or capable, think further afield—someone from your community, a neighbor who you respect and trust, etc.

If possible, name a few people in succession (your estate planning attorney will know how to do this) so if one person cannot serve, then there will be a next-in-line to help.

The next step is to speak with these individuals and explain what you are asking them to do. They need to be comfortable with the responsibility you’re asking them to undertake. You’ll also want to tell them your wishes, perhaps drafting a letter of intent, so they will know what to do in different circumstances. Make sure they know where these documents are located, so they can find them easily.

Once your estate plan is in place, you’ll breathe a sigh of relief, knowing the future is taken care of.

Reference: The Sentinel (June 17, 2022) “Elder Care: Estate planning when you are on your own”

State Bolsters Nursing Home Oversight

The New York State Assembly recently gave final legislative approval in a unanimous vote to a bill requiring the Long-Term Care Ombudsman Program (LTCOP) to publicize, as part of its annual reports, the kinds and patterns of complaints received by its regional offices and the number of ombudsman visits to each long-term care facility.

Harlem World Magazine’s recent article entitled “NYS Lawmakers Move To Strengthen Nursing Home Oversight From Care, To Complaints And More” reports that the New York State Senate passed the companion bill on May 24 with a strong, bipartisan vote.

The move follows a $2.5 million increase in state funding in the 2022 state budget for the federally-required program – more than doubling its previous state-funded budget.

LTCOP has lagged in other states’ programs, while more than 15,000 people have died in New York nursing homes since the start of the COVID-19 pandemic.

“This bill would arm policymakers with the information they need to ensure the Long-Term Care Ombudsman Program is as effective as possible in advocating for and speaking on behalf of our society’s most vulnerable population: nursing home residents,” said AARP New York State Director Beth Finkel.

“After over 15,000 deaths in New York nursing homes and counting since the start of the pandemic, we need a strong advocate. AARP New York thanks Senator Rachel May and Assembly Member Sarah Clark for steering this bill through their respective houses, and we strongly urge Governor Kathy Hochul to sign it into law.”

The New York Ombudsman Program is an advocate and resource for seniors and people with disabilities who live in nursing homes, assisted living and other licensed adult care homes. Ombudsmen help residents understand and exercise their rights to good care in an environment that promotes and protects their dignity and quality of life.

The legislation was supported by the Center for Elder Law & Justice in Buffalo, New York.

Although LTCOP can’t sanction long-term care facilities, it’s the only agency authorized to visit facilities on a regular basis to observe conditions, monitor care and help residents and families resolve problems.

In addition to helping individual residents and families, LTCOP is required by federal rules to act as an independent voice for residents with respect to laws and policies that impact their care.

Reference: Harlem World Magazine (June 4, 2022) “NYS Lawmakers Move To Strengthen Nursing Home Oversight From Care, To Complaints And More”

Elderly Woman Thanks Firefighters for Ride to Visit Husband at Nursing Home

An senior in San Diego was so grateful for the help of local firefighters, she wanted to thank them in person with a big bag of sweets, reports NBC San Diego’s recent article entitled “Stranded La Jolla Woman, 87, Brings Treats to Firefighters Who Gave Her a Lift.”

“It was a long time I was waiting for that cab. If it wasn’t for you, I’d be there all night,” La Jolla resident Sandy Lightman recalled telling San Diego Fire-Rescue Department Captain Jordan Buller on May 10, the night of her “rescue.”

The article said that Mrs. Lightman may have needed a fire engine to haul the three dozen cookies and four cheesecakes to Captain Buller and the Station 35 crew.

The 87-year-old explained that she’d just ended one of her daily trips to a nursing facility, where she cares for her husband who’s living with dementia.

She started requesting a cab around 8:20 p.m., but it didn’t show. So, she kept calling.

Hours later at 11 p.m., while on another call to the facility, Captain Buller and his crew recognized Lightman’s distress.

“She was frantically trying to call family and call a cab and we could tell she was distraught,” he said.

“I can’t walk that well, and I was only two-and-a-half blocks from where I live but I was afraid to go on the street by myself. I didn’t know if I’d make it home,” she said.

Since the cab wasn’t coming, the San Diego fire firefighters loaded Lightman into the cab of their engine.

They strapped her into the jump seat—and even gave her headphones to wear for the trip.

“It felt so secure, it made me feel so good because they were helping me and I knew I was safe, because I was afraid,” said Mrs. Lightman.

Back home safely, the grateful woman says she’s thankful to the local news outlet that was able to help track down the station who treated her with such kindness, so she could spoil them with some sweet treats.

Lightman and her husband will celebrate 40 years of marriage next week.

Reference: NBC San Diego (May 24, 2022) “Stranded La Jolla Woman, 87, Brings Treats to Firefighters Who Gave Her a Lift”

What’s the VA Doing about Long Wait Times?

In his recent testimony before the House Appropriations Committee, Veterans Affairs Secretary Denis McDonough said he’s concerned about delivering accurate information on appointment timeliness to veterans as they seek to resume care that was deferred or canceled in recent years, reports Military Times’ recent article entitled “VA secretary promises improvements in medical wait time data.”

“If you look at our average wait times across the system, they’re good, but it’s a big system and we’re coming out of a pandemic,” he said. “So, I fear that there are outliers where people are waiting too long.”

Wait times at VA facilities made headlines in 2014, after whistleblowers revealed that officials were manipulating data to cover up long delays in care to meet performance metrics. During President Trump’s administration, the department began posting wait-time data online for all VA hospitals and clinics in an attempt to show more transparency into how long veterans have to wait for routine or specialty appointments.

However, in a report released Thursday, the VA Inspector General’s office said much of that data remains confusing and misleading.

“The Veterans Health Administration] has sometimes presented wait times with different methodologies, using inconsistent start dates that affect the overall calculations without clearly and accurately presenting that information to the public,” officials wrote.

In response to similar concerns raised by lawmakers, Secretary McDonough said that “we have to do a better job with that” and said he expects an announcement on changes related to the wait time issues in coming months. We’re working really hard on it because I am frustrated with it myself.”

Broad legislation has been stalled in the Senate over concerns about cost and potential workload burdens on Veterans Affairs workers. That’s raised concerns about pressure on the VA health care system, and if veterans could see a significant increase in the time it takes to schedule appointments.

Health officials have touted new pandemic telehealth options within the department as a way to help ease the burden on facilities facing increased requests.

However, lawmakers said that in rural areas — locations with some of the longest wait times already — a lack of reliable internet access may restrict the availability of those services.

Reference: Military Times (April 8, 2022) “VA secretary promises improvements in medical wait time data”

Can I Help Parents Remember Online Passwords?

Hacked usernames and passwords are the most common causes of malicious online identity attacks, accounting for 61% of breaches.

Seniors Matter’s recent article entitled “Why your loved one needs a password manager” explains that keeping your loved one’s passwords safe is actually nearly as important as the security and complexity of the passwords themselves. This is why a password manager can help. It’s software that allows the user to generate, store and manage credentials in one central and secure location online.

A password manager can help make your loved one’s day-to-day interactions with technology easier and more secure for several reasons. For instance, older adults are vulnerable to scammers, more likely to forget their passwords or store them in unsafe locations. Online accounts should be included in estate planning, but many family members find themselves “locked out” of important accounts after their loved one passes, with no access to the credentials—especially if the death is unexpected.

A password manager puts all your loved one’s online account credentials and documents into one secure place, then they have just one password to remember. Many password managers let you share credentials with other people, so nothing’s ever lost forever. This way they can make certain that the right people will have the details they need to access the accounts necessary to settle the estate.

With many password managers, you can not only store, change and access passwords in these apps but also write notes about information like:

  • Financial account details
  • The location of valuables and important documents
  • Important contact info
  • Important logins or security codes that aren’t website logins; and
  • Instructions in case of death.

Research has shown that older adults who use password managers were satisfied with their experiences overall and even felt confident using multiple features, like the password generator and auto-fill.

After a senior gets over the hurdle of setting up and learning how to use the software, they love it and are quite adept at using it.

This is the reason for you as the caregiver to help your loved one get a password manager set up and help them get acquainted with using it properly.

Reference: Seniors Matter (March 6, 2022) “Why your loved one needs a password manager”

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”

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