Tag Archives: Senior Health

Long Term Care Facilities Overview

When trying to decide what level of assisted living or nursing home care is appropriate for yourself or a loved one, it can often to be difficult to understand the options available for you.

While many times it can be a simple decision (e.g. just an over 50 living facility with maximum independence is often the first step,) often is difficult to judge the level of care needed.  Many people make the decision to meet with a nursing home attorney or elder lawyer to help make the decision.

Here is an overview of the structured facilities for long-term care:

nursing home assistance

ECF (Extended Care Facility): Includes assisted living and both levels of nursing home care.

SNF (Skilled Nursing Facility): As these are only for short term stays that are covered by Medicare and other GMOs, they aren’t a long-term option. Once the allotted number of days under the resident’s insurance plan are used for the year, you will be given the option to pay privately or you must be approved to receive Medicaid long-term to continue to receive care.  You must also have a specific need for short-term occupational and/or physical therapy to stay at a SNF.

ICF (Intermediate Care Facility): This type of facility is for long-term residential care for residents that need 24-hour supervision and care but not at a skilled level.  These types of facilities can be paid for out-of-pocket or through Medicaid.

AL (Assisted Living): This type of facility is not covered by insurance; they are paid for out-of-pocket.  Assisted Living facilities offer minimal care and are not meant for seriously ill patients.  Medicaid will cover the expense if you can qualify for an Assisted Living Waiver – to start that process, get in touch with elder law attorney Adam J. Tobin.

IL (Independent Living): Independent Living facilities are essentially senior communities with meals and activities provided.  It is the lowest level of care offered and is not meant for those with illness or serious mental ailments. These facilities are also paid for out-of-pocket.

If you are trying to figure out the level of care you or a loved one needs, or if you have any questions about the process of selecting a facility, please contact us and arrange a free consultation with Massachusetts estate planning attorney Adam Tobin.

The Financial Health of Aging

With our current economic challenges, those of us looking forward to retirement need to be well-informed about our financial needs in coming years. And not only pre-retirees, but individuals already in retirement need to be wise to the changing economic environment. The good news is there are trained professionals who keep abreast of changes in the current economy, changes in laws and changes in government programs for the elderly. Professionals in this field are equipped to handle everything from help with retirement savings accounts, investment advice, guidance on government programs, estate planning or even new funding options such as reverse mortgages. A little planning prior to retirement will allow you to maintain your current lifestyle; whereas, a lack of planning may require you to live on an extremely tight budget. For those already retired, taking time right now to deal with financial problems instead of waiting for a crisis to happen is well advised.

A large number of retired individuals felt that they had planned well for the future only to find that rising medical costs, damage done to investment portfolios (by the current economy) and many other factors have caused them to go into debt. According to an article in “USA Today”, seniors are racking up debt like never before. Elderly individuals who are in debt live with a constant burden over their heads. Most of these people are on fixed incomes and have no way of paying off credit cards and home equity loans that continue to mount to cover household budget deficits. In order to meet ongoing payments, seniors often forego purchasing medications and skimp on food budgets. They live like hermits — never going out and pinching every penny — in order to pay their obligations.

Most of these people worked hard their entire lives and managed their debt. They never anticipated the rising costs of prescriptions, expensive medical care or depletion of savings by living too long. The good news is there is help for these individuals. Here are just a few examples of some relief options that could be available. There are many more besides these.

Reverse mortgagesAging and financial planning

A reverse mortgage is a risk-free way of tapping into home equity without creating monthly payments and without requiring the money to be paid back during a person’s lifetime. Instead of making payments the cash flow is reversed and the senior receives payments from the bank. Thus the title “reverse mortgage”. For those seniors who are less fortunate financially but own a home, a reverse mortgage can allow them to remain in the home by creating extra income.

Life settlements

A life settlement enables older individuals, businesses and other organizations to sell life insurance policies they currently own – but no longer want or need – for an amount greater than the cash surrender value. In some cases the value can be 2-3 times the cash surrender value. Even some term life insurance policies with a conversion option to permanent coverage can qualify for a life settlement.

Government Programs

Some government programs such as food stamps provide temporary financial help for food. Other programs provide subsidized housing, help with medical expenses and provide tax credits. For veterans there is free health care, inexpensive prescriptions and disability income. Area agencies on aging offer individual counseling, legal help and advice with Medicare costs. (National Care Planning Council, www.longtermcarelink.net)

For some, living on a fixed income and dealing with debt can be an overwhelming burden. There are knowledgeable professionals and debt relief strategies that can assist in easing this burden. The National Care Planning Council keeps a list of financial advisers and attorneys who specialize in this area of planning at www.longtermcarelink.net.

Want to explore these financial issues further for you or a loved one? Be sure to contact an elder lawyer, like Adam J. Tobin today!

Caring for the Caregivers

This blog excerpt is from The New York Times, where author Pauline W. Chen, describes the difficulties caregivers go through for their loved ones.

For all our assertions about the importance of caring in what we do, doctors as a profession have been slow to recognize family members and loved ones who care for patients at home. These “family caregivers” do work that is complex, physically challenging and critical to a patient’s overall well-being, like dressing wounds, dispensing medication, and feeding, bathing and dressing those who can no longer do so themselves.

Many of these caregiving tasks were once the purview of doctors and nurses, a central component of the “caring professions.” But over the past century, as these duties increasingly fell to individuals with little or no training, doctors and even some nurses began to confer less importance, and status, to the work of caregiving.

It comes as no surprise, then, that physicians now rarely, if ever, learn about what a family caregiver or health care aide must do unless they are faced with caring for their own loved ones. We doctors don’t know or aren’t always fully aware of what it takes to care for a patient after we leave the room.

In other words, for the 37 million people attending to the health care needs of a relative, partner, friend or neighbor, our best care goes only so far.

“If you look at the amount of time devoted to actual caregiving, the physician contributes a very modest amount,” said Dr. Arthur Kleinman, a professor of medical anthropology and psychiatry at Harvard Medical School and now a family caregiver himself.

“We’ve had outstanding diagnoses and very careful attention to defining the problem,” Dr. Kleinman said, referring to his own experience. “But once the problem is defined and the limited pharmacological interventions prescribed, there has been neither interest nor knowledge about the rest of the aftercare, even in the most simple parts like finding a home health aide or getting a needs assessment by a social worker.”

But our profession’s indifference may hopefully soon be a thing of the past.

In January 2010, the American College of Physicians, the country’s leading professional organization of internal medicine physicians,

issued its first position paper on working with caregivers. Endorsed by almost a dozen other professional medical organizations, the paper, published in The Journal of General Internal Medicine, highlights the challenges that can arise from the complex interaction among patient, doctor and caregiver and offers guidelines for providing the best care.

Using a framework of broad principles, like the need to respect and maintain a primary focus on the patient’s rights, dignity and values, the paper explores specific issues that are likely to arise in a given patient-doctor-caregiver relationship. How, for example, should physicians approach long-distance family caregivers? What should they consider when working with the caregiver of a terminal patient? How can they best support the caregiver who is convinced that he or she can never do “enough”?

(Entire article can be read here)


Employer Support for Caregiving Employees

“There are only four kinds of people in this world. Those who have been caregivers, those who are caregivers, those who will be caregivers, and those who will need caregivers.” Rosalynn Carter, Former First Lady

The U.S. Department of Labor estimates that in the year 2010, 54% of workforce employees will provide eldercare for a parent or parents and that nearly two-thirds of caregivers will experience conflict between demands at home and demands from employers.

Today’s employed Baby Boomers are the caregiver generation for their parents. They are finding themselves juggling care responsibilities around their employment obligations. Sometimes employees find they have no option but to take leave from work or use sick time to meet their caregiving demands.

Employers also feel the toll it is taking on their employees. A report by the AARP describes the cost to employers:

“Companies are also seeing the emotional and physical toll that caregiving takes on their workers. In one study, 75% of employees caring for adults reported negative health consequences, including depression, stress, panic attacks, headaches, loss of energy and sleep, weight loss, and physical pain. Businesses suffer, too, by having to pay high health insurance costs and in lost productivity. That doesn’t count the promotions or assignments workers turn down that require travel or relocation away from aging relatives.”

Businesses that don’t offer benefits or address eldercare wind up paying for them. A recent study by the MetLife Market Mature Institute and the National Alliance for Caregiving states that U.S. companies pay between $17.1 billion and $33.6 billion annually, depending on the level of caregiving involved, on lost productivity. That equals $2,110 for every full-time worker who cares for an adult.

Eldercare cost businesses:

* $6.6 billion to replace employees (9% left work either to take early retirement or quit)
* Nearly $7 billion in workday interruptions (coming in late, leaving early, taking time off during the day, or spending work time on eldercare matters)
* $4.3 billion in absenteeism” AARP

Typically, human resource departments work with employees on many issues that may affect their work productivity.  There are programs for drug and alcohol abuse, domestic violence, illness, absenteeism and child care; but, help with eldercare issues is not normally provided.

The AARP report follows several companies who are providing help with eldercare issues and what they are doing for their employees.

* “Freddie Mac has a free eldercare consultant and access to subsidized aides for a relative up to 20 days.
* Verizon Wireless offers seminars on eldercare issues and allows full-time workers 80 hours a year in back-up care, 40 hours for part-time, and $4/hour for in-home help.
* At the Atlanta law firm Alston & Bird LLP, workers can donate vacation time to colleagues who have used up theirs to care for family members. “ AARPadam-tobin

A growing number of companies nationwide are directing their HR departments to provide resources, education and group help for caregiving issues by:

* Providing materials from community resources such as phone numbers to their local Senior Centers or Area Agencies on Aging.
* Making available brochures and booklets on specific programs and services by eldercare experts
* Providing speakers to educate employees on caregiving options
* Allowing options to use paid sick leave, employee job sharing and flexible hours
* Allowing employee caregivers to use business computers for caregiving research
* Contracting with companies who provide eldercare services to help employees

Eldercare service providers are also reaching out to help employee caregivers by providing informational presentations at the work place during lunch time or other times set up by employers. One such presentation provided information on reverse mortgages. Jason, who had been trying to help his parents pay for home care, learned at a work site presentation that a reverse mortgage was one way to cover caregiver expenses.

The HR Department of a local business in Utah, invited the Salt Lake Eldercare Planning Council to present a “Brown bag, Lunch and Learn” during their employees’ lunch hour. In 30 minutes time, those who attended learned how the services of a Care Manger, Home Care Provider, Elder Attorney, Medicaid Planner and Financial Consultant can help with caregiving decisions. Problems were discussed, questions answered and employees left armed with information and the names of professional people they knew could help them.

“This was the most productive lunch I have ever attended”, related Mary, one of the attendees.

“I had been very hesitant to contact an attorney to discuss my parents’ estate, because of the cost involved.  The attorney at our ‘lunch and learn’ answered my few basic questions which will allow me to prepare what I need before I meet with him to finalize my parents’ estate planning.”

Besides workplace help for employers and employees dealing with caregiving, the internet is also a great research tool.  The National Care Planning Council website at www.longtermcarelink.net is a comprehensive resource for eldercare, senior care and long term care planning.  It contains hundreds of articles on all aspects of eldercare.  Professional providers list their services on the NCPC website.  Each of their listings provides unique information on specific eldercare services and how to obtain help.

Employers, employees and eldercare service providers working together can make parent or senior caregiving a workable solution for all.

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?


•    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?


•    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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