Olivia K. Smith on Families & Seniors

How to Prepare for an Aging Parent’s Care

April 19, 2021Filed Under: Elder Law, Medicaid Planning, Senior Health and Wellness

One truism of providing care for an aging parent one is preparation is crucial to success. Whether you need basic information about eldercare resources and services, are looking for a local agency to provide those services, or have worries about legal documents or how to finance your parents’ care needs now or in the future, the time to begin planning is today.

The American Public Broadcasting Service (PBS) and television program distributor provides an online handbook, Caring for Your Parents, that offers good preparedness strategies. These planning strategies, links, and tools are also transferable for spousal care, other elderly relatives, or caring for a loved one who is chronically or critically ill with significant ongoing needs. The PBS handbook, designed by WGBH Educational Foundation and the MIT Workplace Center, addresses a wide variety of situations and is even appropriate when considering your own needs as you age.

In terms of an aging parent, it all begins with an open and honest conversation. You might be fortunate and know your parents are well prepared for their future, but most Americans will face situations where loved ones will require additional help and resources. If your parents have a solid aging plan with proper legal documents and financial backing, know that you can access that paperwork and account information.

If there is no plan in place, talk with your parents about future changes with appropriate family members. Take small steps to prevent overwhelming your parents, listen carefully, and be prepared for some denial. Discuss living at-home safety, bringing in outside services and caregivers into their home. Also, broach assisted living or nursing homes and if your parents’ have a valid will and health care proxy. Define their healthcare and living needs for the present and the future.

When locating services remember all eldercare is ultimately local, and services vary widely among states and regions. If you care for your elder parent but do not live nearby, look for resources in the state and neighborhood where your loved one lives. Be persistent; no one resource has all the answers. You may receive advice that something cannot happen when in fact, it can. Request an “Information and Referral” (I&R) specialist. These specialists have the proper training to answer a wide range of questions and connect you to services.

Much of your search will be on the internet. Your search can be overwhelming as there is so much information about eldercare, so be sure to use trustable sites for data. The PBS Caring for Your Parents Handbook’s links can specifically help navigate eldercare services and information complexities, whether the needs be moderate or significant.

Aside from identifying and using eldercare services, the Handbook contains information about finances, legal issues, insurance, home care, housing and transportation, health care, activities, and strategies for caregiver wellness. You can cross-reference data you uncover using the AARP online forums, where people share experiences, ask and answer questions, and learn from each other. Or use the AARP search tool entering phrases like “caring for your aging parent” for articles, books, and guides that you can compare with the PBS Handbook.

When establishing a care plan for your aging parents, realize that good intentions can quickly derail without legal documents in place permitting you to make decisions on their behalf. The quality of life and end-of-life care your parents receive is inextricably linked to proper legal documentation. When making plans and acquiring eldercare services, be certain to speak with an elder law attorney who can provide an overview of the aging process from a legal perspective and identify your parents’ specific needs. Health care proxies and living wills will enable you to make decisions based on your parents’ beliefs, values, and wishes when they are no longer able to decide for themselves.

As elder law attorneys, we consult with families on both care and legal needs of family members as the two are closely related and should be considered together. If you would like to discuss your particular needs, we would be honored to speak with you. Please don’t hesitate to contact us at 513-771-2444.

Undue Influence and Estate Planning

April 12, 2021Filed Under: Elder Law

The elderly have, unfortunately, always been more susceptible to manipulation from those who will defraud or steal from them. Targeted attacks on vulnerable older people to exert what attorneys deem “undue influence” constitutes elder abuse. It disrupts the older persons’ impulse to provide for loved ones and instead leaves assets to the manipulator. Often, family members do not find out about a change in estate plan until after their loved one has died. Most often, a manipulator will seek to keep last-minute changes of inheritance quiet.

If you believe undue influence was at play regarding the will of your deceased love one, you can take your suspicions to probate court. Proving undue influence can prompt the probate judge to rule that the will and other estate planning documents are invalid. Contesting undue influence is allowable even if there is no regular probate court proceeding to probate the will and distribute estate assets.

A probate judge will look for a claimant to prove that the will either

Leaves property in an unexpected manner, cutting out close family members in favor of others without an obvious explanation before their death
The will-maker may have been particularly trusting of, or dependent on, the influencer, sometimes referred to as a confidential relationship
Frailty, illness, or fear of abandonment make the will-maker susceptible to undue influence
The confidential relationship influencer took outright advantage of the will-maker and directly benefited by substituting a will of their choosing and not the will-makers.

Undue influence is not the same as meddling or offering unsolicited advice or opinions to an aging family member. As long as a will-maker is mentally and physically independent, they can follow or disregard opinion and advice as they choose. The situation changes when physical frailty or cognitive decline can leave a will-maker susceptible to undue influence. As an example, out of need, an older person might welcome a cousin into their home to provide them care. That older person’s children may have suspicions about the cousin’s motivation or begin to experience estrangement from their loved parent. In this event, direct conversations with the will-maker and their permission to confirm through their attorney that the will and estate documents have not changed may be necessary.

Proving undue influence in probate court will require testimony from people who knew the will-maker well, such as medical doctors and health care providers, caregivers, lawyers, and other advisers, as well as family members. These individuals then testify about what they know regarding the relationship between the deceased individual and the person being accused of exerting undue influence.

Because probate courts try to adhere to the last “voice” of the decedent, the best and least expensive way to prevent undue influence is to have an open discussion with your loved one or aging parent. Discuss their estate planning and its impact on all generations in the family well in advance of them becoming vulnerable. According to a survey by Caring.com, only 45 percent of adult children discuss what their parents’ plans are for when they need care. And only 30 percent discuss who will pay for and manage their care. Even during the COVID-19 pandemic, only a small percentage of Americans have the proper estate planning documentation. Acting now to prevent potential abuse is vastly preferable to introducing allegations of undue influence in probate court.

If your loved one is already having difficulty making rational decisions, including estate planning options, for their well-being, seek a guardianship or conservatorship through the courts. Appointing a trusted person will ensure the respect of a loved one’s wishes and prevent undue influence. If they are capable, review existing estate plans and share feelings openly. If no plan exists, encourage your parents to contact an elder law attorney and discuss the need for a will, trust, or both. Understanding and helping loved ones with aging preparations should be a family priority, and open discussion can prevent undue influence.

If you believe a loved one may have been the victim of undue influence (or is currently being influenced) please give us a call. We would be happy to discuss your situation confidentially. Please don’t hesitate to contact us at 513-771-2444.

CDC and CMS Loosen Nursing Home Restrictions

April 5, 2021Filed Under: Senior Health and Wellness

After a dramatic decrease in COVID-19 infections and deaths, along with the US vaccination program, the Centers for Medicare and Medicaid (CMS) and the Centers for Disease Control and Prevention (CDC) are permitting the ease of in-person visitation restrictions within nursing homes. According to McKnight’s Long-Term Care News, a statement by CMS further provides, “Facilities should allow responsible indoor visitation at all times and for all residents, regardless of the vaccination status of the resident, or visitor, unless certain scenarios arise that would limit visitation.”

The CMS Press release and Fact sheet provide detail regarding the new guidelines and acknowledge the toll that isolation through separation has taken upon nursing home residents and loved family members and friends. The need for physical contact is universal for emotional, mental, and physical well-being. As long as a nursing home resident is fully vaccinated, they may choose close contact with their visitor, including hugs. A caveat is that the visitor will wear a proper fitting facemask and continue to physical distance from other residents and facility staff. According to the guidelines, visitors do not have to show proof of vaccination or require testing before entering a facility due to vaccination programs within nursing homes.

CMS will require visitation limits for the following reasons

Unvaccinated residents in the case where the county positivity rate of COVID-19 is greater than 10 percent and less than 70 percent of residents in the facility are completely vaccinated
Whether vaccinated or not, residents with confirmed COVID-19 infection, until they meet the criteria to discontinue transmission-based precautions or
Residents in quarantine, whether vaccinated or not, until they meet criteria for release from quarantine

Outdoor visitation is still preferable, which the advent of spring will help to facilitate however preference does not dictate policy which states facilities must allow responsible indoor visitation at all times. Handwashing, particularly after close interaction, remains a must, as do properly fitting facemasks.

The easing of visitation guidelines comes almost a year to the day federal authorities first closed nursing homes to visitation on March 13, 2020. Today, if an outbreak occurs, even in a single case of a resident or staff member, visitation is suspended until the facility conducts a full round of outbreak testing. Visits may resume if the outbreak is contained, but providers must stop visits for 14 days after the last new case if it is not. Routine testing of staff will continue, as will inquiries to visitors if they have come in contact with someone with COVID-19. Strong infection control protocols remain in place within the facilities.

Nursing homes are the recipients of some of the highest priorities in the federal vaccination program hierarchy, leading to an astonishing drop in COVID-19 infections and deaths. The end of March 2021 will mark the third of three government-run clinics on nursing home sites. The federal government’s focus on vaccinating nursing home residents and facility staff is a success story. During the week of February 21, 2021, national data shows there were just more than 1,900 new resident COVID-19 cases reported in nursing homes. This statistic represented an enormous drop from peak week in late December 2020 when 33,625 weekly cases were reported.

Bringing more families safely together for the well-being of nursing home residents will remain a priority. Maintaining infection prevention practices will continue given the still high risk of transmission of COVID-19, particularly among the elderly. However, the new CMS guidelines bring hope and human contact to the many nursing home residents who have been suffering greatly, more than many of us, during the coronavirus pandemic.

If you have questions or would like to discuss your personal situation, please don’t hesitate to contact us at 513-771-2444.

Seniors Often Experience Late-Life Anxiety

March 29, 2021Filed Under: Senior Health and Wellness

Anxiety is a common thing that older Americans experience. Some reports estimate between 10 and 20% of seniors have generalized anxiety. This number could be even higher, as many often deny having psychological issues when asked by their doctors, focusing more on the physical symptoms anxiety can cause.

In a recent article, Hany Abdelaal, President of VNSNY Choice Health Plans, describes late-life anxiety this way. “It’s a pattern familiar to many of us with aging parents: the overwhelming worry or constant nervousness over day-to-day tasks, from taking medications to parking the car. Left untreated, this anxiety-related agitation in the elderly can disrupt sleep and eating, exacerbate chronic medical conditions, and ultimately contribute to a downward spiral of fear and isolation.”

As his article explains, older adults may have anxiety or worry about physical health (illness, changes in vision or hearing), cognitive difficulties, finances, and changes in life status (widowhood, care-giving responsibilities, retirement). They may feel anxious about keeping medications straight (sometimes to the point of giving up and stopping them altogether), not having enough groceries in the house, driving, and falling.

Anxiety is often accompanied by symptoms that mimic physical illness and may include muscle tension or pain, GI symptoms, shortness of breath, and heart palpitations. Symptoms can also include sleeplessness, an inability to concentrate, irritability, and lack of focus. As a result, complaints are often more about these physical symptoms than the anxiety causing them.

The good news is that anxiety can be treated. Stress can be reduced with social support, communication, education and, if needed, counseling and medication.

Social Support: When there is no one around to provide support or an alternate point of view, anxiety can cause irrational fears to grow. It’s critical to have a support system of family, friends and neighbors who can provide social contact by telephone, email and personal visits. Religious organizations can provide community and a place to visit regularly; most have visitation for those who are homebound. Senior centers can also provide social support.

Communication and Education: Living with chronic medical conditions and managing multiple medications can often trigger anxiety in elderly people, especially if they do not fully understand their situation. Medications should be routinely evaluated and, if possible, reduced. Patients need to understand what they are taking and why, what the desired effect is, and possible side effects. A caregiver or family member should accompany an older person to each doctor’s visit, prepared to ask questions and take notes. A family member can also “join” the appointment via Facetime or speaker phone. Upon request, the doctor’s office can provide a written care plan and prescribed medications at the end of each appointment.

Counseling and Medication: Many anxiety sufferers can benefit from psychological counseling in which they learn to reframe thoughts and behaviors, and challenge their irrational fears. Stress management techniques may be helpful. There are also a number of medications that can help reduce anxiety symptoms. Before adding another medication to what may be an already stressful multi-drug program, a doctor should fully evaluate the patient’s overall situation, reducing or streamlining medications where possible. That said, the addition of one of these medications can make a major difference in the life and outlook of an older person suffering from anxiety.

If you’d like to discuss your particular situation, please don’t hesitate to reach out. Please contact our Cincinnati office by calling us at 513-771-2444 with any questions.

How to Prepare for an Aging Parent’s Care

Undue Influence and Estate Planning

CDC and CMS Loosen Nursing Home Restrictions

Seniors Often Experience Late-Life Anxiety

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