Estate Planning Blog Articles

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What are Latest Trends in Senior Care Facility Design?

iAdvance Senior Care’s recent article entitled “The Newest Trends in Senior Care Facility Design” interviewed Christine Cook, NCARB, principal with the Dallas-based design boutique three. She explained that she’s seeing several new trends that are shaping the industry.

“Owners and operators are working to connect through lifestyle choices, in combination with a healthcare amenity, to reach the target pool of prospective residents. ‘Active aging’ and ‘purposeful lifestyles’ resonate favorably with both residents and their families. This shifts the perception away from residency as need-based or compelled to a feeling of joining the community by choice,” she remarked.

Other design trends include more tailored residential apartments and cottages. There is also an increased demand for amenities, both on-site and within walking distance.

“Also, it is foundational to ensure consistency of the design aesthetic and quality of materials across the continuum-of-care, from independent living to assisted living and memory care,” says Cook.

Cook also said that many existing communities are decreasing their skilled nursing offerings. They’re customizing assisted living and memory care environments, tailoring them to the residents’ needs. “Most new communities are not incorporating skilled nursing at all.”

The COVID-19 pandemic has also prompted an increased focus on cleanliness and practical material selection. “Escalating cleaning protocols are demanding increased attention to the selection of finishes,” says Cook.

“Materials must be durable and resilient, otherwise replacing them when they wear out will have to be cost-effective — think modular cabinetry or tile flooring. We have also had to address plans for processional arrival sequences at entryways, modifying and limiting them to ensure there will be no security breaches with respect to disease migration.”

She’s also seen an uptick in requests for no-touch access controls for resident and staff-only areas. Cook notes that there’s also a market preference for larger balconies and full-height windows to allow for more natural daylight. Designs that reinforce healthy connections to nature, like balconies doubling as outdoor great rooms, can prompt residents to be more inspired and engaged.

However, Cook says that owner-operators frequently describe two common challenges: Keeping occupancy rates high and attracting and retaining high-quality, mission-focused staff.

Cook thinks that several trends will continue to define the senior care market in the future. These include increased demand for pocket-park communities, which usually consist of 10 to 12 cottages that are organized around or near an activity center. These communities are often developed in association with a larger senior care community or health provider.

Reference: iAdvance Senior Care (Oct. 12, 2021) “The Newest Trends in Senior Care Facility Design”

Will Congress Provide more Dollars for Elder Care?

For millions of Americans taking care of elderly or disabled loved ones, resources are very costly. Government assistance is provided through Medicaid, but it’s just for those with the lowest incomes. Many who qualify don’t get the help because many states restrict the number of eligible recipients, resulting in long waiting lists.

NBC News’ recent article entitled “Democrats want billions to pay for elder care. Republicans say the price tag is too high” reports that Democrats have earmarked roughly $300 billion to expand home-based care for seniors and the disabled in the $3.5 trillion spending bill dubbed the American Families Plan. The bill would offer states incentives to lift their income caps to 300 times the poverty level, or about $38,600 per person. Democrats say it would enable an additional 3.2 million people to be eligible for home-based assistance.

However, Republicans are launching an all-out messaging campaign that accuses Democrats of a “reckless tax and spending spree” and saying the American Families Plan would lead to higher inflation and a suffering economy. Democrats say they aren’t afraid of the cost or of Republican claims about inflation. Research shows that the elder care proposal is one of the most popular components of their agenda among likely Democratic voters. Two-thirds of voters said expanding access to home-based care for the elderly and the disabled was important, and 48% strongly favored the expansion.

Progressives have said $3.5 trillion is too little to transform the economy. Moderate Democrats point to the risk of inflation.

U.S. Rep. Katherine Clark (D-MA), who is a member of the House Women’s Caucus, cared for her dad, who suffered a stroke, her mom, who had Alzheimer’s and three young children when she was running for Congress. She said elder care is a priority.

“Even though I had resources and options, it was really, really challenging to me. That story plays out for parents and women across this country every day,” Clark said in an interview. “It is long past time that we recognize how fundamental the care agenda and the care economy is to our economy in general.”

Democrats also would like to pass provisions to guarantee that home health care workers make a living wage through reporting guidelines and by requiring a minimum wage, which would be set by region.

Reference: NBC News (Aug. 21, 2021) “Democrats want billions to pay for elder care. Republicans say the price tag is too high.”

What Is Elder Law?

With medical advancements, the average age of both males and females has increased incredibly.  The issue of a growing age population is also deemed to be an issue legally. That is why there are elder law attorneys.

Recently Heard’s recent article entitled “What Are the Major Categories That Make Up Elder Law?” explains that the practice of elder law has three major categories:

  • Estate planning and administration, including tax issues
  • Medicaid, disability, and long-term care issues; and
  • Guardianship, conservatorship, and commitment issues.

Estate Planning and Administration. Estate planning is the process of knowing who gets what. With a will in place, you can make certain that the process is completed smoothly. You can be relieved to know that your estate will be distributed as you intended. Work with an experienced estate planning attorney to help with all the legalities, including taxes.

Medicaid, Disability, and Long-Term Care Issues. Elder law evolved as a special area of practice because of the aging population. As people grow older, they have more medically-related issues. Medicaid is a state-funded program that supports those with little or no income. The disability and long-term care issues are plans for those who need around-the-clock care. Elder law attorneys help coordinate all aspects of elder care, such as Medicare eligibility, special trust creation and choosing long-term care options.

Guardianship, Conservatorship, and Commitment Matters. This category is fairly straightforward. When a person ages, a disability or mental impairment may mean that he or she cannot act rationally or make decisions on his or her own. A court may appoint an individual to serve as the guardian over the person or as the conservator the estate, when it determines that it is required. The most common form of disability requiring conservatorship is Alzheimer’s, and a court may appoint an attorney to be the conservator, if there is no appropriate relative available.

Reference: Recently Heard (May 26, 2021) “What Are the Major Categories That Make Up Elder Law?”

Link Possible between Diabetes, Dementia and Age

New research says those people who had type 2 diabetes for more than 10 years had more than twice the risk for developing dementia, as compared with those who were diabetes-free at age 70, according to Archana Singh-Manoux, PhD, of the Université de Paris in France.

MedPage Today’s recent article entitled “Diabetes, Dementia, and Age: What’s the Link?” reports that at age 70, every additional five years younger that a person was diagnosed with diabetes was linked to a 24% increased risk of incident dementia, even after adjustment for sociodemographic, health-related and clinical factors including cardiovascular disease, hypertension, body mass index and use of antidepressant or cardiovascular medications, among others.

This is equal to a dementia rate of 8.9 per 1,000 person-years among patients age 70 without diabetes versus a rate of 10 to 18.3 for those with diabetes, depending on age at onset:

  • Diabetes onset 5 years earlier: 10.0 per 1,000 person-years
  • Diabetes onset 6-10 years earlier: 13.0 per 1,000 person-years
  • Diabetes onset 10+ years earlier: 18.3 per 1,000 person-years

The strongest connection with incident dementia appeared to be younger age at onset of type 2 diabetes. Patients at age 55 who were diagnosed with diabetes within the past five years saw a twofold increased risk for incident dementia; those age 60 who were diagnosed with diabetes six to 10 years prior saw a similar twofold increased risk. However, late-onset diabetes wasn’t found to be tied to incident dementia. Prediabetes (fasting blood glucose of 110-125 mg/dL) also was not linked to risk of subsequent dementia. Singh-Manoux said this finding suggested that “a certain threshold of high glucose” might be needed to ultimately see hyperglycemia-induced brain injury.

However, cardiovascular comorbidities played into this link. Patients with diabetes who also had a stroke had a dramatically higher risk for dementia. Those with three heart conditions — stroke, coronary heart disease and heart failure – were at five times increased risk for subsequent dementia. Thus, these findings emphasize the importance of age at diabetes onset and cardiovascular comorbidities, when determining risk for dementia, the study authors said.

A few possible explanations could explain the connection between diabetes and dementia. “One hypothesis is that brain metabolic dysfunction is the primary driver of Alzheimer disease, highlighting the role of decreased transport of insulin through the blood-brain barrier, impairments in insulin signaling and consequently decreased cerebral glucose utilization,” they wrote. This idea was supported by findings from the 2019 SNIFF trial, which found some benefit with 40 IU of daily intranasal insulin for Alzheimer’s disease patients. The group also suggested that episodes of hypoglycemia, more often experienced by those with a longer diabetes duration, may increase the risk for dementia.

Reference: MedPage Today (April 27, 2021) “Diabetes, Dementia, and Age: What’s the Link?”

Does Zinc or Vitamin C Fight COVID?

New research shows that if you take either zinc or vitamin C (ascorbic acid) (or a combination of the two), it doesn’t dramatically reduce the severity or the duration of symptoms associated with COVID-19, according to the Cleveland Clinic.

Money Talk News’ recent article entitled “These 2 Supplements Don’t Curb COVID-19 Danger After All” reports that these findings were recently published in the American Medical Association’s journal JAMA Network Open.

In the past, there had been some thought that vitamins and supplements like zinc and vitamin C might provide some benefits to people hoping to avoid or treat COVID-19.

Zinc can help immune function, and the mineral plays a part in antibody and white blood cell production. Zinc is also known to fight infections. Vitamin C is an antioxidant that decreases the damage to cells and boosts the immune system.

However, researchers at the Cleveland Clinic found that among 214 adult patients known to have COVID-19, taking 10 days of zinc gluconate (50 milligrams per day) or vitamin C (8,000 milligrams over the course of each day), or a combination, had no impact on the amount of time it took for their symptoms to subside, compared to patients receiving standard care.

That is actually why the study was stopped early.

In an announcement, Dr. Milind Desai, director of clinical operations in Cleveland Clinic’s Heart Vascular and Thoracic Institute and co-principal investigator of the study, commented:

“As we watched the pandemic spread across the globe, infecting and killing millions, the medical community and consumers alike scrambled to try supplements that they believed could possibly prevent infection, or ease COVID-19 symptoms. However, the research is just now catching up. While vitamin C and zinc proved ineffective as a treatment when clinically compared to standard care, the study of other therapeutics continues.”

The researchers at the Cleveland Clinic also saw that the patients in the study who were getting outpatient care rather than being treated in a hospital (like those who contract COVID-19 but don’t need hospitalization) are more likely to decline supplements.

The study participants also had an average age of about 45 years, and about 62% were women.

Reference: Money Talk News (Feb. 15, 2021) “These 2 Supplements Don’t Curb COVID-19 Danger After All”

Tips for Caregiving during the Pandemic

The Harvard Health Letter provides some great tips in its recent article entitled “Caregiving during the pandemic” to make certain that a loved one is receiving the best care.

Direct Communication. If your elderly family member can communicate well, talk to them daily and remember that when you ask basic questions like “How are you feeling?” “Are you eating and drinking enough?” “Are you getting enough sleep?” However, that you may not get a straight answer. They may just tell you what you want to hear. Therefore, try to get a more realistic picture. Listen to how they sound on the call, and see if they sound different, sad, confused, or tired. Ask them how they’ve been spending their time and who they’ve seen that day. Look for clues that they may be getting sick.

Speak with The Staff. Ask questions. Start with the director of nursing or a caseworker. You can tell the staff you’re worried and that you may be asking more questions than usual. Find out how often they’re able to give you updates and have a list of questions that includes the following aspects of your loved one’s health and well-being.

  • Socialization. Ask if your family member is participating in activities or just staying in their room most of the time. If they’re not getting out, ask about a plan to get them back into a healthy social and physical routine.
  • Does the staff feel your senior is in generally good spirits, or is there an issue? Is this impacting their health or daily activities?
  • Physical Strength. Is your parent having difficulty rising from a chair or feeling unsteady when walking? Inactivity can diminish muscle strength and cause falls. Get them into an exercise routine or physical therapy.
  • Eating Habits. Are they eating and drinking enough, and what is the staff doing to encourage nutrition and hydration? A change in eating and drinking habits can mean a change in mood and should be addressed by a doctor.
  • Have any medications been added or eliminated recently, and for what reason?
  • Continence. Ask if your senior is able to get to the bathroom on time. If they’re incontinent, what’s the plan to deal with this issue?
  • Hygiene. Is your elderly loved one is able to bathe, brush his or her teeth and do other bathroom activities? If not, ask how often the staff is providing assistance.
  • Cognitive Skills. Ask if there’s been any change in your loved one’s ability to reason or have a conversation. In some cases, it might be linked to something fixable, like medication side effects or a urinary tract infection.

If You Find an Issue. Inform the staff about your concerns, especially if you suspect a new problem. Arrange a visit with a physician and try to be on the call if possible.

Social interaction is also important, so encourage loved ones to take part in activities at their facility. In the same fashion, try to connect with your loved one in any way possible. Make frequent visits if they’re allowed, drop off a care package, a card, flowers, or a picture from a grandchild. This is the best way to stave off feelings of isolation and loneliness that so many people in facilities experience.

Reference: Harvard Health Letter (March 2021) “Caregiving during the pandemic”

How Can I Prep for a Telehealth Appointment with My Doctor?

Caring Bridge’s August 2020 article entitled “5 Tips to Prepare for a Telehealth Appointment” shares five steps to prepare for a virtual doctor’s appointment that will allow you to get the most out of your telehealth experience.

  1. Check your Technology. You need a computer, smartphone, or tablet with a camera. Without a camera, it’s just a phone call, which may not be as effective, since your doctor can’t observe any physical symptoms or your physical expressions during the chat. Get the software and test it out beforehand.
  2. Get Your Medical Info Handy. You may be asked to fill out and return symptom and history forms by the day before your appointment. You should also be sure to write down notes for yourself for the predictable questions you’ll be asked during the visit itself like: When did this start? What makes the pain or issue better or worse? Don’t waste time trying to think through the answers to these questions on the spot.
  3. Be Ready to Do Your Own Physical Exam. Be ready to participate in your own physical exam. You may want to get a good scale, thermometer and blood pressure monitor to conduct your own exam. If you are able, on the day of your call, measure and document your blood pressure, heart rate, temperature, respiratory rate, and weight. You should also wear clothing that will make it easy to do the necessary show and tell during the call.
  4. Make a List of Your Questions. Create this list for the doctor in advance of your visit and be sure to prioritize them to make sure your main issues are addressed first. If all your questions aren’t covered, ask for a follow up telehealth visit.
  5. Sit in a Comfortable Spot. A typical telehealth visit takes about 20 minutes. Use the bathroom beforehand and have a glass of water handy, so you don’t have to get up. Create a comfortable, quiet space.

Remember, telehealth visits aren’t a replacement for ALL visits. You should be seen in-person if you believe you or a loved one are experiencing a heart attack, stroke, a head injury, trauma, or bleeding.

Telehealth is a terrific way to deliver medical care, provided we know its limitations.

Make the most of your visit by following these tips.

Reference: Caring Bridge (Aug. 18, 2020) “5 Tips to Prepare for a Telehealth Appointment”

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”