Estate Planning Blog Articles

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What’s the Best Way to Find the Right Assisted Living Facility?

News 19 Alabama’s recent article entitled “How To Choose the Right Assisted Living Facility,” provides some valuable tips for researching assisted living facilities and finding the best option for you:

Get recommendations. Ask friends, family and your doctor about assisted living facilities in the area and if they would recommend them. If someone you know lives in an assisted living facility, ask them how they like it, as their experience can provide insight into what facilities have the best reputation in your local area.

Consider your needs. Residents in assisted living facilities typically need assistance with some basic activities of daily living. This includes bathing, dressing, eating, and getting around. Some assisted living communities specialize in caring for people with specific conditions, such as Alzheimer’s. The level of care assisted living facilities offer can vary greatly, so consider how much assistance you require.

Consider the cost. Remember that Medicare doesn’t cover assisted living costs, which is why most people pay with private funds even though it’s expensive.

Consider location. A facility near friends and families is often the best choice. This lets residents receive lots of visitors. Employees will also see that the resident’s visitors scrutinize their care.

Ask questions. Before calling assisted living facilities, consider these questions:

  • How many residents live at the facility?
  • Are pets allowed?
  • What amenities are available to residents?
  • Are there personalized care plans for each resident?
  • How are additional services billed?
  • Are there doctors, nurses, pharmacists, physical therapists, housekeepers, cooks, and activity directors on staff?
  • Does the facility run background checks on staff?
  • What happens if a resident’s health deteriorates and needs additional care or a hospital stay?
  • What safety features does each residential unit feature?
  • What is the staff-to-resident ratio during the day and at night?
  • What are the meals the facility serves?
  • Are all utilities included in the overall cost of a unit?

Take note when you visit. When you tour a facility, look at the cleanliness, activities, safety features, available common areas, the friendliness of the staff and how healthy and happy the residents appear.

Compare several facilities before you decide. Don’t just choose the first facility you visit. Instead, tour several facilities and compare them.

Carefully examine contracts. Read assisted living contracts from start to finish and look for unexpected fees or deposits.  Yous should also pay attention to the rules regarding discharging or evicting a resident, late or missed payments and how the facility handles (or limits) your rights to file a lawsuit should there be an issue.

Reference: News 19 (May 14, 2023) “How To Choose the Right Assisted Living Facility”

Will I Be Able to Afford Nursing Home Care?

About 60% of older adults — or 24 million households — wouldn’t have the resources to pay for in-home long-term care, despite the fact that they would prefer to “age in place,” per a National Council on Aging report.

Fox News’ recent article entitled, “Most seniors in America can’t afford nursing homes or assisted living, study finds,” says that the researchers looked at 2018 data from the Health and Retirement Study, which was a joint effort by the National Institute on Aging and the Social Security Administration that surveyed some 20,000 U.S. adults about their net wealth.

When the researchers started examining the data some years ago, they were initially surprised to see that so many older adults were at severe risk of financial insecurity, Dr. Jane Tavares, a lead researcher at the LTSS Center at UMass Boston, told Fox News Digital.

“There is a common misconception that older adults are asset-rich, but we have found in our research that this is not generally true,” she said.

Dr. Tavares also noted, “We expect that there will probably be some worsening, once we examine data for the period covering the COVID pandemic.”

The national average cost for assisted living is $4,500 per month. However, it can vary significantly depending on the location and level of care needed.

“As the population continues to age and demand for these services grows, it is likely that the cost will continue to rise,” said Dr. Steven Norris, a senior health and care expert who is also the medical director at Transitions Care in Chicago, Illinois.

The widespread shortage of qualified caretakers means facilities must pay more to secure the right people.

“For decades, there has been a lack of awareness of how expensive assisted living really is.” “Additionally, recent increases in minimum wage requirements and changes in overtime payment legislation are increasing assisted living costs,” he said.

The cost could range from $3,000 in rural areas to $7,000 to $9,000 in urban locations.

“For decades, there has been a lack of awareness of how expensive assisted living really is,” Kim told Fox News Digital.

“Some people thought health insurance would cover long-term care costs, while other people optimistically believed that they would live a healthy life forever.”

Assisted living companies had to raise prices to keep up with their costs continually. However, retirees did not see the same growth in savings or investments. Middle-aged and older adults are also now facing a very different financial landscape than the generations before them did. More than the increases in household income and assets have also been needed to keep up with rising living costs, health care and inflation. Even when older adults have assets, they are often tied up in property and need to be more readily available to help them cover costs.

The changing retirement model has also added to gaps in savings. Past generations had private, employer-sponsored pensions that provided predictable payments. Many Americans now rely on 401(K) accounts, leaving individuals responsible for saving enough money to cover their retirement years.

“With all of this combined, few older adults have any significant savings in retirement accounts — and most can’t afford long-term care insurance that would help cover the expensive costs of assisted living or nursing home care,” she explained.

“With private long-term care insurance being unaffordable for most older adults, it is key to begin considering combined public and private initiatives that can put the cost of coverage within reach and make it more appealing to consumers,” she said.

Reference: Fox News (April 26, 2023) “Most seniors in America can’t afford nursing homes or assisted living, study finds”

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”

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

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 are States Doing to Help Pay Long-Term Care Costs in Future?

Starting this year, workers in Washington state must pay 58 cents of every $100 they earn into the Washington Cares Fund. That money will help pay their long-term care costs in the future. Those with qualifying long-term care insurance can be eligible for an exemption.

Next Avenue’s recent article entitled “How Medicaid and Medicare Fit Into Planning for Long-Term Care” says that starting in 2025, those Washington residents who’ve paid in for at least three out of the prior six years, or for 10 years in total, will be able to withdraw up to $36,500 to pay for their costs of care. It is an effort by the state to fill in a major gap in our long-term care system. California has also enacted a law to bring down the eligibility threshold for Medicaid to totally eliminate it by the end of 2023. New York state is considering similar legislation.

Any senior may need assistance as they age, whether due to dementia, illness, loss of eyesight, or simple frailty. The level of assistance and how long it will last can vary greatly. However, few retirees have enough saved to pay for their care for very long out-of-pocket. According to research from Boston College, more than half of today’s 65-year-olds will need a medium to high level of assistance for more than a year. Almost two thirds of that care will be provided by family members – mostly children and spouses – for no cost, but more than a third will be provided by paid caregivers.

According to the Congressional Research Service, 43% of long-term care services are paid for by the Medicaid program, 20% by Medicare, 15% out-of-pocket and 9% by private insurance. The rest comes from a combination of private and public sources that includes charitable payments and VA benefits.

Medicare Coverage. This is the federal health insurance program for people beginning at age 65. Note that Medicare only covers so-called “skilled” needs following a hospitalization. It pays for up to 100 days of care in a skilled nursing facility following a hospitalization and longer term for home health services.However, the home health coverage is not comprehensive.

Medicaid Coverage. The financial rules for Medicaid coverage are complicated and state-specific. However, generally people must spend down to about $2,000 in savings and investments. Planning to use Medicaid to pay for long-term care is also complicated by the fact that while its coverage of nursing home care is comprehensive, its payment for home care and assisted living facility fees is only partial and differs both from state to state. Even if you may be able to leverage Medicaid to help pay home and assisted living care, you must also rely on your own savings.

Out-of-Pocket Costs. The low percentage of long-term care costs paid for out-of-pocket is surprising, in light of the vast growth of both assisted living and private home care agencies over the last several decades. However, this demonstrates the fact that most older adults have limited resources to pay for anything beyond their basic living expenses. When the need for care arises, they must rely on family members or Medicaid.

Insurance. A large component of insurance coverage of long-term care consists of Medicare supplemental insurance payments for skilled nursing facility copayments. While Medicare will pay for up to 100 days of skilled care following a hospitalization, it actually pays entirely for only the first 20 days. For days 21 through 100, there is a copayment which for most is paid by their MediGap insurance. As such, long-term care insurance pays for a very small share of long-term care costs. For those who have coverage, it can be terrific. However, due to its high cost, those who have it often also have the resources to pay for their care out-of-pocket, at least for some period of time.

Veterans Benefits. More vets are taking advantage of a Veterans Administration benefit known as Aid & Assistance that will provide veterans who qualify financially with up to $2,431 a month (in 2022) to help pay for their care.

Reference: Next Avenue (Feb. 2, 2022) `“How Medicaid and Medicare Fit Into Planning for Long-Term Care”

What’s Elder Law and Do I Need It?

Yahoo News  says in its recent article entitled “What Is Elder Law?” that the growing number of elderly in the U.S. has created a need for lawyers trained to serve clients with the distinct needs of seniors.

The National Elder Law Foundation defines elder law as “the legal practice of counseling and representing older persons and persons with special needs, their representatives about the legal aspects of health and long-term care planning, public benefits, surrogate decision-making, legal capacity, the conservation, disposition and administration of estates and the implementation of their decisions concerning such matters, giving due consideration to the applicable tax consequences of the action, or the need for more sophisticated tax expertise.”

The goal of elder law is to ensure that the elderly client’s wishes are honored. It also seeks to protect an elderly client from abuse, neglect and any illegal or unethical violation of their plans and preferences.

Baby boomers, the largest generation in history, have entered retirement age in recent years.  Roughly 17% of the country is now over the age of 65. The Census estimates that about one out of every five Americans will be elderly by 2040.

Today’s asset management concerns are much sophisticated and consequential than those of the past. Medical care has not only managed to extend life and physical ability but has itself also grown more sophisticated. Let’s look at some of the most common elder law topics:

Estate Planning. This is an area of law that governs how to manage your assets after death. The term “estate” refers to all of your assets and debts, once you have passed. When a person dies, their estate is everything they own and owe. The estate’s debts are then paid from its assets and anything remaining is distributed among your heirs.

Another part of estate planning in elder law concerns powers of attorney. This may arise as a voluntary form of conservatorship. This power can be limited, such as assigning your accountant the authority to file your taxes on your behalf. It can also be very broad, such as assigning a family member the authority to make medical decisions on your behalf while you are unconscious. A power of attorney can also allow a trusted agent to purchase and sell property, sign contracts and other tasks on your behalf.

Disability and Conservatorship. As you grow older, your body or mind may fail. It is a condition known as incapacitation and legally defined as when an individual is either physically unable to express their wishes (such as being unconscious) or mentally unable to understand the nature and quality of their actions. If this happens, you need someone to help you with activities of daily living. Declaring someone mentally unfit, or mentally incapacitated, is a complicated legal and medical issue. If a physician and the court agree that a person cannot take care of themselves, a third party is placed in charge of their affairs. This is known as a conservatorship or guardianship. In most cases, the conservator will have broad authority over the adult’s financial, medical and personal life.

Government programs. Everyone over 65 will, most likely, interact with Medicare. This program provides no- or low-cost healthcare. Social Security is the retirement benefits program. For seniors, understanding how these programs work is critical.

Healthcare. As we get older, health care is an increasingly important part of our financial and personal life. Elder law can entail helping a senior understand their rights and responsibilities when it comes to healthcare, such as long-term care planning and transitioning to a long-term care facility.

Reference: Yahoo News (Jan. 26, 2020) “What Is Elder Law?”

What Is Elder Law?

WAGM’s recent article entitled “A Closer Look at Elder Law“ takes a look at what goes into estate planning and elder law.

Wills and estate planning may not be the most exciting things to talk about. However, in this day and age, they can be one of the most vital tools to ensure your wishes are carried out after you’re gone.

People often don’t know what they should do, or what direction they should take.

The earlier you get going and consider your senior years, the better off you’re going to be. For many, it seems to be around 55 when it comes to starting to think about long term care issues.

However, you can start your homework long before that.

Elder law attorneys focus their practice on issues that concern older people. However, it’s not exclusively for older people, since these lawyers counsel other family members of the elderly about their concerns.

A big concern for many families is how do I get started and how much planning do I have to do ahead of time?

If you’re talking about an estate plan, what’s stored just in your head is usually enough preparation to get the ball rolling and speak with an experienced estate planning or elder law attorney.

They can create an estate plan that may consists of a basic will, a financial power of attorney, a medical power of attorney and a living will.

For long term care planning, people will frequently wait too long to start their preparations, and they’re faced with a crisis. That can entail finding care for a loved one immediately, either at home or in a facility, such as an assisted living home or nursing home. Waiting until a crisis also makes it harder to find specific information about financial holdings.

Some people also have concerns about the estate or death taxes with which their families may be saddled with after they pass away. For the most part, that’s not an issue because the federal estate tax only applies if your estate is worth more than $12.06 million in 2022. However, you should know that a number of states have their own estate tax. This includes Connecticut, Hawaii, Illinois, Maine, Massachusetts, Minnesota, New York, Oregon, Rhode Island, Vermont and Washington, plus Washington, D.C.

Iowa, Kentucky, Nebraska, New Jersey, and Pennsylvania have only an inheritance tax, which is a tax on what you receive as the beneficiary of an estate. Maryland has both.

Therefore, the first thing to do is to recognize that we have two stages. The first is where we may need care during life, and the second is to distribute our assets after death. Make certain that you have both in place.

Reference: WAGM (Dec. 8, 2021) “A Closer Look at Elder Law“

Can Fluffy Come to the Nursing Home with Me?

Several studies show the benefits of pets, and senior care communities are increasingly adopting pet-friendly policies.

IAdvance Senior Care’s recent post, “How Senior Care Community Design is Changing to Become More Pet-Friendly,” explains that pets can provide many valuable benefits in senior care settings, particularly because of their effects on mental and physical health. One study found that the presence of dogs was linked to less agitation and fewer behavioral issues for Alzheimer’s patients. In fact, according to News in Health, pets have been shown to help decrease the stress-related hormone, cortisol and lower blood pressure in residents who interact with our furry friends. Studies have also proven that pets can boost mood, reduce loneliness and help seniors feel they have social support.

In addition to health benefits, pets can also provide an important consistency for those who may be moving into a senior care setting. Many people see pets as family members, and a pet-friendly community that permits new arrivals to bring pets with them can avoid a painful separation.

More senior care communities are adopting pet-friendly policies, which can require design changes.

According to Natalie Ruiz, AIA, LEED, AP, NCARB, CDT, associate principal at CallisonRTKL, senior care communities that adopt a more pet-friendly approach see multiple benefits. “For residents, having a pet helps combat loneliness, increases social interaction and gives a sense of purpose,” she explains. “For communities, they see their residents thrive with increased mobility resulting from walking a dog or grooming a cat. There’s also a simple uptick in the job and happiness that comes with the residents having a sense of purpose.”

Ruiz says that in addition to designs and renovations that accommodate residents’ pets, some facilities also benefit from pet therapy programs that introduce community pets for residents to enjoy. In these instances, the facility’s residents still have access to animal companionship but don’t have the time or financial commitments of pet ownership. With the benefits of pets, care communities are increasingly requesting new pet-friendly elements. Ruiz said more and more senior care communities are working to include dog parks with dog washes and pet water fountains. Dog runs are also popular requests.

Ruiz says that while facilities can easily create dog-friendly spaces, they should also give some thought to creating a space for cat lovers. She also suggests that a care center trying to become pet-friendly should designate a pet coordinator who can help the residents with pet care.

Reference:  iAdvance Senior Care (Nov. 30, 2021) “How Senior Care Community Design is Changing to Become More Pet-Friendly”