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How to Be an Effective Advocate for Elderly Parents

Family caregivers must also understand their loved one’s wishes for care and quality of life. They must also be sure those wishes are respected. Further, it means helping them manage financial and legal matters, and making sure they receive appropriate services and treatments when they need them.

AARP’s recent article entitled “How to Be an Effective Advocate for Aging Parents” says if the thought of being an advocate for others seems overwhelming, take it easy. You probably already have the skills you need to be effective. You may just need to develop and apply them in new ways. AARP gives us the five most important attributes.

  1. Observation. Caregivers can be too busy or tired, to see small changes, but even slightest shifts in a person’s abilities, health, moods, safety needs, or wants may be a sign of a much more serious medical or mental health issue. You should also monitor the services your family member is getting. You can take notes on your observations about your loved one to track any changes over time.
  2. Organization. It’s hard to keep track of every aspect of a caregiving plan, but as an advocate, you must manage your loved one’s caregiving team. This includes creating task lists and organizing the paperwork associated with health, legal, and financial matters. You’ll need to have easy access to all legal documents, like powers of attorney for finances and health care. If needed, you might take an organizing course or work with a professional organizer. There are also many caregiving apps. You should also, make digital copies of key documents, such as medication lists, medical history, powers of attorney and living wills, so you can access them from anywhere.
  3. Communication. This may be the most important attribute. You need communication for building relationships with other caregivers, family members, attorneys and healthcare professionals. Be prepared for meetings with lawyers, medical professionals and other providers.
  4. Probing. Caregivers need to gather information, so don’t be shy about it. Educate yourself about your loved one’s health conditions, finances and legal affairs. Create a list of questions for conversations with doctors and other professionals.
  5. Tenacity. Facing a dysfunctional and frustrating health care system can be discouraging. You must be tenacious. Here are a few suggestions on how to do that:
  • Set clear goals and focus on the end result you want.
  • Keep company with positive and encouraging people.
  • Heed the advice of experienced caregivers’ stories, so you understand the triumphs and the challenges.
  • Be positive and be resilient.

Reference: AARP (Sep. 24, 2020) “How to Be an Effective Advocate for Aging Parents”

The Difference between Power of Attorney and Guardianship for Elderly Parents

The primary difference between guardianship and power of attorney is in the level of decision-making power, although there are many intricacies specific to each appointment, explains Presswire’s recent article entitled “Power of Attorney and Guardianship of an Elderly Parent.”

The interactions with adult protective services, the probate court, elder law attorneys and healthcare providers can create a huge task for an agent under a power of attorney or court-appointed guardian. Children acting as agents or guardians are surprised about the degree of interference by family members who disagree with decisions.

Doctors and healthcare providers don’t always recognize the decision-making power of an agent or guardian. Guardians or agents may find themselves fighting the healthcare system because of the difference between legal capacity and medical or clinical capacity.

A family caregiver accepts a legal appointment to provide or oversee care. An agent under power of attorney isn’t appointed to do what he or she wishes. The agent must fulfill the wishes of the principal. In addition, court-appointed guardians are required to deliver regular reports to the court detailing the activities they have completed for elderly parents. Both roles must work in the best interest of the parent.

Some popular misperceptions about power of attorney and guardianship of a parent include:

  • An agent under power of attorney can make decisions that go against the wishes of the principal
  • An agent can’t be removed or fired by the principal for abuse
  • Adult protective services assumes control of family matters and gives power to the government; and
  • Guardians have a responsibility to save money for care, so family members can receive an inheritance.

Those who have a financial interest in inheritance can be upset when an agent under a power of attorney or a court-appointed guardian is appointed. Agents and guardians must make sure of the proper care for an elderly parent. A potential inheritance may be totally spent over time on care.

In truth, the objective isn’t to conserve money for family inheritances, if saving money means that a parent’s care will be in jeopardy.

Adult protective services workers will also look into cases to make certain that vulnerable elderly persons are protected—including being protected from irresponsible family members. In addition, a family member serving as an agent or family court-appointed guardian can be removed, if actions are harmful.

Agents under a medical power of attorney and court-appointed guardians have a duty to go beyond normal efforts in caring for an elderly parent or adult. They must understand the aspects of the health conditions and daily needs of the parent, as well as learning advocacy and other skills to ensure that the care provided is appropriate.

Ask an experienced elder law attorney about your family’s situation and your need for power of attorney documents with a provision for guardianship.

Reference: Presswire (Jan. 14, 2021) “Power of Attorney and Guardianship of an Elderly Parent”

What are the Issues with COVID Vaccinations Sign-ups for Seniors?

With states across the U.S. providing the COVID-19 vaccine to people 65 and older, seniors are trying to determine how to make an appointment to receive their shots. Many government agencies ask people to make appointments online. However, website errors, overwhelmed phone lines and a collection of changing rules are frustrating seniors who are frequently less tech-savvy, may live farther from vaccination sites and are less likely to have Internet access—especially minority populations and the poor.

ABC News’ recent article entitled “Online sign-ups complicate vaccine rollout for older people” reports that almost 9.5 million seniors (16.5% of Americans 65 and older) lack internet access, according to U.S. Census Bureau data. Moreover, the access is worse for minority seniors, with more than 25% of Black people, about 21% of Hispanic people and over 28% of Native Americans age 65 and older have no way to get online. Compare that with 15.5% of white seniors.

In the San Francisco Bay Area, Dr. Rebecca Parish has been saddened by the bureaucratic red tape and continued calls for help from seniors. An 83-year-old patient called her in tears, unable to navigate the online appointment system at her local drugstore. After several of these types of calls, Dr. Parish took action. She contacted Contra Costa County and acquired 500 doses to vaccinate people at a middle school in Lafayette, California. She’s also working with nonprofits to identify seniors who don’t live in nursing homes and risk falling through the cracks. All her appointments have been taken, but she’ll begin adding more when more doses are available.

Many health officials have been trying to find other solutions to ease the confusion and help senior citizens sign up, as the Trump administration asked states to make the nation’s 57.6 million seniors eligible for the COVID-19 vaccine.

Some spots have discovered that simple ideas can work. For example, in Morgantown, West Virginia, county health officials used a large road construction sign to list the phone number for seniors to call to make an appointment. Some are looking at working with community groups or setting up mobile clinics for more remote populations.

Some medical systems, like UCHealth in Colorado, are trying to partner with community groups to get vaccines to underserved populations, like seniors. Local doctors are volunteering at a clinic hosted by a church that brings in the vaccine and helps build trust between health care workers and residents.

For now, UCHealth schedules appointments online, but a COVID-19 hotline is in the works because of the volume of calls from seniors. Howwever, even a Colorado health provider setting up vaccine clinics for underserved communities, Salud Family Health Centers, said their phone lines aren’t equipped to handle the number of calls they’re getting and encouraged people to go online.

Reference: ABC News (Jan. 15, 2021) “Online sign-ups complicate vaccine rollout for older people”

Can Mom Live in the Backyard?

When one Georgia senior thought about moving closer to her daughter in an Atlanta suburb, she realized she couldn’t afford to buy a home.

Therefore, her daughter researched building a cottage in her own backyard. This fall, they made a deposit on a Craftsman-style design by a local architect who will manage the project from permits to completion. The 429-square-foot home will have one bedroom and bathroom, a galley kitchen and living area and a covered porch.

Kiplinger’s recent article entitled “A Retirement Home Is a Tiny House in the Kids’ Backyard” reports that driven by an aging population and a scarcity of affordable housing, accessory dwelling units (ADUs) are a new trend in multigenerational living. These units are also known as in-law suites, garage apartments, carriage houses, casitas and “granny flats.” Freddie Mac found the share of for-sale listings with an ADU rose 8.6% year-over-year since 2009.

Homes such as these can be created by finishing a basement or attic, converting a garage, reconfiguring unused space, adding on, custom-building a detached unit, or installing a prefab. This unit can also be a source of rental income. A homeowner could also use it to house a parent, child or caregiver; downsize into it themselves to rent the main house; or make it into an office or guest quarters.

Converting existing space is less expensive than building a detached unit. A prefab ADU is cheaper and quicker to install than one built on site. However, a custom project allows you to include aging-in-place features, like a step-free entry, wider doorways and a handicapped accessible shower.

An ADU also allows seniors some privacy, so they’ll feel at home, rather than a visitor or intruder. You might add a private entrance and soundproofing to the shared walls of an in-law suite. Sitting areas indoors and outdoors will let you or a parent enjoy solitude, entertain friends without asking for permission and avoid feeling locked in.

Prior to using your nest egg to create an ADU on a child’s property, think about the way in which you’ll pay for the care you will inevitably need someday. You can’t sell the ADU to raise funds and renting it out after you’ve moved elsewhere is unlikely to cover the cost of your care.

In addition, note that if a parent gives a child money to build an ADU within the look-back period when applying for Medicaid, they may be penalized with delayed coverage.

Reference: Kiplinger (Dec. 31, 2020) “A Retirement Home Is a Tiny House in the Kids’ Backyard”

States with Most Affordable Long-Term Care?

Seven in 10 people 65 and older will require some type of long-term care during their lifetime. This expense will vary based on the patient’s required level of care, care setting and geographic location, says Think Advisor’s recent article entitled “15 Cheapest States for Long-Term Care: 2020.”

A recent study by Genworth found that the cost for facility and in-home care services increased on average from 1.9% to 3.8% per year from 2004 to 2020. That amounts to $797 annually for home care and as much as $2,542 annually for a private room in a nursing home.

At the current rate, some care costs are more than the 1.8% U.S. inflation rate, Genworth said.

These findings were taken from 14,326 surveys completed this summer by long-term care providers at nursing homes, assisted living facilities, adult day health facilities and home care providers. The survey encompassed 435 regions based on the 384 U.S. Metropolitan Statistical Areas, as defined by the U.S. Office of Management and Budget.

In a follow-up study, Genworth also found that these factors are contributing to rate increases for long-term care:

  • Labor shortages
  • Personal protective equipment (PPE) costs
  • Regulatory changes, such as updated CDC guidelines
  • Employee recruitment and retention issues
  • Wages demands; and
  • Supply and demand.

Here are the 15 cheapest states for long-term care, according to Genworth with their average annual cost:

15. Utah: $59,704

14. Kansas: $57,766

13. Iowa: $57,735

12. Kentucky: $57,540

11. South Carolina: $57,413

10. Tennessee: $56,664

9. North Carolina: $56,512

8. Georgia: $53,708

7. Mississippi: $52,461

6. Arkansas: $50,835

5. Oklahoma: $50,641

4. Texas: $48,987

3. Missouri: $48,753

2. Alabama: $48,240

1. Louisiana: $44,811

Reference: Think Advisor (Dec. 14, 2020) “15 Cheapest States for Long-Term Care: 2020”

What Do I Need to Know as a Caregiver for the Elderly?

Not everyone is cut out for assisting older people because the job requires a unique skillset and, more importantly, empathy.

Big Easy’s recent article entitled “6 Things to Consider as a Caregiver for the Elderly” says it can be hard to understand that a senior has become dependent on others, and being assisted in everyday tasks may even lead to compromises in their privacy. This can put a senior in stressful conditions that lead to anxiety. In that case, hiring a professional caregiver for the elderly may be the best option.

However, no matter your training, caring for an older person can still be challenging. Consider these six things to develop the best possible relationship with the elderly and to provide the best care.

Compassion. Being compassionate helps develop a better connection to the elderly person. This can frequently solve many behavioral problems and can make for a pleasant caregiving environment. Most older people have some physical or mental disability that keeps them from being independent. In some situations, being abandoned by their loved ones creates even more emotional damage. To help, be empathetic and kind to them in these difficult times. This can significantly help to decrease the emotional pain that accompanies old age and illness. Being compassionate is one of the most effective ways of delivering the best care possible in these situations.

Communication. If you have the ability to have natural and comfortable conversations with elderly patients, you can develop a tighter emotional bond with them. Healthy communication and conversations also can distract a senior from things that may be troubling them, which will not only benefit the patient but will also help you carry out your tasks more easily. You may also be called upon to interact with other family members or doctors, so good communication skills are required.

Safety. Safety is vital for the elderly, and the slightest negligence can become a matter of life and death for them. The most common types of injuries for older people are attributed to falls. It is also even more dangerous because their bones are weak and don’t heal quickly. Use extreme care when assisting seniors in slippery areas, like the bathroom. Take precautions, such as de-cluttering the house and eliminating tripping hazards. Most importantly, keep them under constant observation, especially those with mental illnesses.

Hygiene. Maintaining quality hygiene can be a challenge, especially if people are shy or want their privacy. Take bathing as an example: it’s not surprising that the elderly are embarrassed, when caregivers have to bathe them. Even so, you are tasked with maintaining their hygiene. If you don’t, it can lead to more health-related issues.

Medications. Most seniors take medication, some of which produce side effects, such as nausea or dizziness. As a caregiver, you should make certain that they are taking their medicines on time and watch for side-effects in the case of an emergency. Review their medications and administer the prescribed dosage at the right times yourself. This will also help those who forget to take their medicines without prompting.

You may have several challenging times throughout your career as a caregiver for the elderly, but empathy and compassion will help you considerably. You will create a better job experience and help the elderly with a very difficult phase of their life.

Reference: Big Easy (Dec. 10, 2020) “6 Things to Consider as a Caregiver for the Elderly”

What Should I Know, If I Need to Take an Elderly Person to the Doctor?

First, know and understand the rules in the pandemic.

AARP’s August 17 article entitled “4 Things to Know When Taking a Loved One to the Doctor During COVID-19” provides four other things to consider as you plan doctors’ appointments.

Is there an urgent need for the appointment? A caregiver of a senior may be tempted to schedule some appointments. However, doctors are trying to return to normal, and even with precautions in place, they may not want to see your senior for a non-urgent visit. Right now, most doctors don’t advise patients to come into their office for routine follow-ups. See if the visit can be postponed or ask the medical office about a virtual visit on Zoom.

Do you know the office’s visitor policy? If the doctor asks you to bring your loved one to the doctor’s office, look at its visitor policy before you go. With COVID-19, most offices have very strict policies and may only permit scheduled patients in the office. Some will make exceptions for a senior’s caregiver if needed, but they may request that once the patient is checked in, the caregiver wait in the car.

What are the facility’s precautions against COVID-19? In most health care facilities, as well as in imaging centers, doctors’ offices, hospitals with outpatient services, ERs and labs, there’s intense facility cleaning and sanitizing, universal masking, physical distancing and hand sanitizing. Patients are typically met at the door with a thermometer and a COVID-19 questionnaire. Other precautions include removing magazines to protect against the risk of virus transmission and requiring all staff to wear surgical masks.

What preparation is needed for an in-person appointment? Both the caregiver and patient should wear masks and get there punctually. When you make the appointment and it is prep for a scheduled surgery or procedure, ask if the patient needs a COVID-19 test.

You should also bring a list of medications with dosages and frequencies (and the number of refills left.). It is also helpful to have on hand a medical history that includes symptoms, dates and durations. This can be valuable in completing the COVID-19 questionnaire and to get more from the appointment. You should also have a list of questions for the doctor.

When you leave the appointment, be certain: (i) all of the patient’s questions have been answered; (ii) review the instructions for home care provided in the treatment plan; and (iii) schedule the next appointment, if a follow-up is needed.

Reference: AARP (Aug. 17, 2020) “4 Things to Know When Taking a Loved One to the Doctor During COVID-19”

What Did the Supreme Court Say about Medicaid Work Requirements?

The Trump administration had asked the Supreme Court in July to reinstate its historic approvals of state work requirements waivers. It contends that these rules may assist certain beneficiaries in transitioning to private policies and may result in improved health and to help states conserve financial resources to provide coverage to others in need.

MSN’s article entitled “Supreme Court agrees to consider Medicaid work requirements” reports that lower courts have struck down the Department of Health and Human Services’ approvals, holding that Medicaid’s primary purpose is to provide health care coverage.

The National Health Law Program, one of the consumer advocacy groups that brought the original lawsuits, said it thinks it will win at the Supreme Court.

“HHS’s action was properly vacated because Secretary [Alex] Azar failed to account for the significant loss in health coverage that these approvals would produce,” said Jane Perkins, legal director at the National Health Law Program. “Tens of thousands of people would lose their Medicaid coverage and become uninsured.”

The Supreme Court’s decision to take up the cases follows a panel of federal appellate judges that struck down the Trump administration’s approval of work requirements in Arkansas in February. The unanimous decision, written by Judge David Sentelle, a Reagan appointee, affirmed a district court ruling that found the administration had failed to analyze whether these programs would “promote the primary objective of Medicaid — to furnish medical assistance.”

New Hampshire stopped its roll-out of work requirements last year after the same district judge, James Boasberg in DC, set aside the administration’s approval in that state.

In an unprecedented step two years ago, the Trump administration started granting state requests to mandate that certain Medicaid beneficiaries work to receive benefits. Republicans have long wanted to have that requirement with Medicaid, which insures more than 75 million low-income Americans.

There were 12 states that received waivers, although four were set aside in court, according to the Kaiser Family Foundation. Another seven state requests are awaiting federal approval. Work requirements are not in effect anywhere, after states stopped their efforts because of the legal rulings and the pandemic.

In Arkansas, more than 18,000 people lost coverage in 2018, before the court intervened. Judge Boasberg had also canceled Kentucky’s approval. That move blocked work requirements from being implemented in the state. However, Kentucky withdrew its waiver request after a Democratic governor won election in 2019 and dismissed its appeal.

The judge blocked work requirements in Michigan earlier this year.

Reference: MSN (Dec. 5, 2020) “Supreme Court agrees to consider Medicaid work requirements”

debts after death

What Debts Must Be Paid after I Die?

When you pass away, your assets become your estate, and the process of dividing up debt after your death is part of probate. Creditors only have a certain amount of time to make a claim against the estate (usually three months to nine months).

Kiplinger’s recent article entitled “Debt After Death: What You Should Know” explains that beyond those basics, here are some situations where debts are forgiven after death, and some others where they still are required to be paid in some fashion:

  1. The beneficiaries’ money is partially protected if properly named. If you designated a beneficiary on an account — such as your life insurance policy and 401(k) — unsecured creditors typically can’t collect any money from those sources of funds. However, if beneficiaries weren’t determined before death, the funds would then go to the estate, which creditors tap.
  2. Credit card debt depends on what you signed. Most of the time, credit card debt doesn’t disappear when you die. The deceased’s estate will typically pay the credit card debt from the estate’s assets. Children won’t inherit the credit card debt, unless they’re a joint holder on the account. Likewise, a surviving spouse is responsible for their deceased spouse’s debt, if he or she is a joint borrower. Moreover, if you live in a community property state, you could be responsible for the credit card debt of a deceased spouse. This is not to be confused with being an authorized user on a credit card, which has different rules. Talk to an experienced estate planning attorney, if a creditor asks you to pay off a credit card. Don’t just assume you’re liable, just because someone says you are.
  3. Federal student loan forgiveness. This applies both to federal loans taken out by parents on behalf of their children and loans taken out by the students themselves. If the borrower dies, federal student loans are forgiven. If the student passes away, the loan is discharged. However, for private student loans, there’s no law requiring lenders to cancel a loan, so ask the loan servicer.
  4. Passing a mortgage to heirs. If you leave a mortgage behind for your children, under federal law, lenders must let family members assume a mortgage when they inherit residential property. This law prevents heirs from having to qualify for the mortgage. The heirs aren’t required to keep the mortgage, so they can refinance or pay off the debt entirely. For married couples who are joint borrowers on a mortgage, the surviving spouse can take over the loan, refinance, or pay it off.
  5. Marriage issues. If your spouse passes, you’re legally required to pay any joint tax owed to the state and federal government. In community property states, the surviving spouse must pay off any debt your partner acquired while you were married. However, in other states, you may only be responsible for a select amount of debt, like medical bills.

You may want to purchase more life insurance to pay for your debts at death or pay off the debts while you’re alive.

Reference: Kiplinger (Nov. 2, 2020) “Debt After Death: What You Should Know”

transfer a house

Is Transferring House to Children a Good Idea?

Transferring your house to your children while you’re alive may avoid probate. However, gifting a home also can mean a rather large and unnecessary tax bill. It also may place your house at risk, if your children get sued or file for bankruptcy.

You also could be making a mistake, if you hope it will help keep the house from being consumed by nursing home bills.

There are better ways to transfer a house to your children, as well as a little-known potential fix that may help even if the giver has since died, says Considerable’s recent article entitled “Should you transfer your house to your adult kids?”

If a parent signs a quitclaim to give her son the house and then dies, it can potentially mean a tax bill of thousands of dollars for the son.

Families who see this error in time can undo the damage, by gifting the house back to the parent.

People will also transfer a home to try to qualify for Medicaid, but any gifts or transfers made within five years of applying for Medicaid can result in a penalty period when seniors are disqualified from receiving benefits.

In addition, transferring your home to another person can expose you to their financial problems because their creditors could file liens on your home and, depending on state law, take some or most of its value. If the child divorces, the house could become an asset that must be divided as part of the marital estate.

Section 2036 of the Internal Revenue Code says that if the parent were to retain a “life interest” in the property, which includes the right to continue living there, the home would remain in her estate rather than be considered a completed gift. However, there are rules for what constitutes a life interest, including the power to determine what happens to the property and liability for its bills.

There are other ways to avoid probate. Many states and DC permit “transfer on death” deeds that let homeowners transfer their homes at death without probate.

Another option is a living trust, which can ensure that all assets avoid probate.

Many states also have simplified probate procedures for smaller estates.

Reference: Considerable (Sep. 18) “Should you transfer your house to your adult kids?”

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