Monthly Archives: April 2009

Questions you must ask a prospective Nursing Home

Often times, people who are assisting a family member or other loved ones in transitioning to a nursing home are overwhelmed at the task at hand.  I strongly encourage these individuals to visit the nursing home armed with this helpful list of questions written by the Executive Office of Health and Human Services:

Health Care and Services
•    Can residents retain their personal physician if they wish?
•    Will a resident be moved out of the facility if additional care is needed?
•    Do residents have input in the development of care plans?
•    Are rehabilitation programs and therapies offered, as appropriate?
•    What are the policies on “do not resuscitate” and “advance directives”?
•    If applicable, does the facility meet the Alzheimer’s Association criteria?
•    Does the facility offer specialized programs or services?

Staffing

•    What is the staff to resident ratio?
•    What are the facility’s hiring and staffing policies?
•    How are prospective employees screened?
•    What kind of training do new employees receive?

Accommodations

•    Is there adequate privacy and space in resident rooms?
•    What personal possessions are permitted in resident rooms?
•    How are items protected from theft?
•    If rooms are shared, how are roommates selected?
•    What happens if roommates are not compatible?
•    What are the policies on transfer and relocation of residents?
•    Are there activity rooms and lounge areas for resident use?
•    Are the bathing and food preparation areas clean and accessible?

Meals and Resident Activities
•    Are meals served in an appealing manner and at proper temperature?
•    Ask to sample a meal.
•    Are there food choices?
•    Are there accommodations for special diets?
•    Are snacks and drinks available between meals?
•    Is there an active residents’ council?
•    Are special events held at or outside the facility and what is scheduled?
•    Are there religious or cultural activities offered?

Family Visits
•    What are the facility’s policies concerning family visits?
•    Are there designated visiting hours?
•    What space is available for visits?
•    Are there limitations on the number of visitors or frequency of visits?
•    Are family members permitted to join relatives for occasional meals?

Payment Policies
•    Is the facility approved to accept Medicare or Medicaid patients?
•    What is the billing and payment policy?
•    What is included in the daily/monthly rate?
•    Are there any additional charges?
•    How long will the bed be held if the resident is hospitalized?

Facility Environment
•    Do the residents appear to be well cared for, properly groomed, and dressed appropriately for the season and time of day?
•    Do staff seem to be friendly, caring and accommodating to residents, visitors and others?
•    Do staff members respond promptly to resident’s requests?
•    Is the facility clean?
•    Are there strong odors in the facility?
•    Is the facility well maintained, pleasing and cheerful?
•    Are the exits clearly marked and accessible?

Survey Reports
•    When was the facility’s last survey conducted?
•    Is the most recent survey report available in the facility? If so, where?
•    Have cited deficiencies been corrected?
•    If corrected, when and how were they corrected?
•    How will the facility prevent them from recurring?
•    If deficiencies are not yet corrected, what is the facility’s plan for correcting?

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How to choose a nursing home

Choosing a nursing home for you or a family member is one of the most difficult and stressful decisions. Choosing either a short-term stay after a hospital visit or a more permanent placement can be overwhelming.  How do you choose the right place?

Here are some tips to follow when choosing a nursing home…

A good first step clearly is to be well informed, and to begin your search online is wise. However, searching online and receiving recommendations is not enough. Not to mention, there is a lot of information out there, and narrowing down your list can be a daunting task. You can use this nursing home search site to get information on choosing a nursing home that’s right for you.

Once you have narrowed down your choice to a few care facilities that you would like to consider, a visit will be your next step. As you visit a home you should keep track of the following items with a thorough checklist of things you want to evaluate:

  • Overall facility appearance and atmosphere, location and grounds
  • Observe not only the facility and staff, but also the residents
  • Check the safety of lobbies, hallways, stairs and lounges
  • Atmosphere and attitudes of staff, as well as other administrative checks
  • Medical and nursing care availability
  • Available activity rooms and activity schedules
  • Nursing home rights and personal freedoms
  • Dining areas and dietary services
  • Resident rooms and private living spaces
  • Bath and shower areas

View the full nursing home checklist with detailed tips and things to look for during your search on www.mass.gov.

Checklists and tools like the ones I listed are important because you can’t always judge a book, or in this case a facility, just by its appearance. If upon your visit, a facility does not look or smell clean, and if the residents seem poorly cared for that is probably an indication that you want to look somewhere else.

If you need help evaluating a nursing home either because you aren’t sure of what to look for, or if you live outside of Massachusetts and you are trying to find placement for a relative here I hope this information helps you make the right choice for yourself or your loved one.

What do you look for when you visit facilities? What have your experiences been? Have you used other tools to help you in your search? I’d love you hear your story.

Related links to help you assess long term or short term care facilities:
1. What is Nursing Home Care: http://www.masslongtermcare.org
2. AARP’s Advice on choosing a nursing home: http://www.aarpmagazine.org/health
3. Nursing home checklists: http://www.aging-parents-and-elder-care.com

Are there ways to avoid estate taxes?

Co$ Enjoys Unfair Tax Exemptions
Image by LafayetteBeacon via Flickr

Yes. I frequently counsel clients to reduce and often eliminate estate taxes through various techniques, including but not limited to:

  • Drafting Credit Shelter Trust Provisions; whereby spouses leave some of their property in trust for their children, but give the surviving spouse the ability to access some or all of it for the remainder of their life. This keeps the second spouse’s taxable estate half the size it would be if the property were left entirely to the spouse.
  • Drafting “QTIP” Trust Provisions; whereby couples can postpone estate taxes until the second spouse dies.  This allows for additional gifts qualifying for the annual exclusion.
  • Drafting Charitable Remainder Annuity Trusts; whereby a tax free gift is made to a tax-exempt charity and the surviving spouse and/or children receive perpetual income from the transfer.
  • Drafting Irrevocable Life Insurance Trusts; whereby the value of life insurance proceeds is removed from the client’s estate.
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How does the Gift Tax work?

Gift Taxes work in conjunction with the Estate Tax. Essentially, the government makes little distinction for gifts made during ones life (gift tax) and gifts made after ones life (estate tax).

Although Gift Taxes are placed on gifts given away to any person while you are still living, one may still give up to $13,000 as of January 2009 in cash or assets to an unlimited number of people each year without incurring Gift Tax liability. Married couples can give as a couple $26,000 per year to as many people as they want.

But remember, if someone (or a couple jointly) gives more than the limit annually, the excess is applied toward their lifetime gift-tax exclusion, which reduces their estate tax credit at death. Moreover, if at any point the gifts they gave you during their life exceed this unified credit then they must pay a gift tax on the excess amounts over the credit.

As an aside, any gift transferred between spouses (where both are US citizens) of any size is 100% Gift Tax-Free.  This fact may make it tempting to transfer assets between spouses but must be analyzed in conjunction with an estate plan and a professional estate planning attorney.   This simple gift may result in your family paying a tremendous amount of unnecessary gift/estate taxes.

I would be more than happy to look at your situation and determine the most effective way to help your family transfer their assets.  Contact me for a free consultation at 978-725-9083.