health care | Olivia K. Smith, Attorney at Law

Before a Medical Emergency Occurs, Learn About Your Parents’ Aging Strategies

May 9, 2022Filed Under: Elder Law, Estate Planning

In the US, many adult children live far away from their parents. Managing aging parents or in-law medical events can be a serious challenge without proper preparation and understanding of what your parents’ strategy may or may not be, no matter where you live. Do you know what legal documentation your parents have in place regarding their medical care? Do they have advance directives that can help guide your medical decision-making process? Do you and your spouse openly discuss the situations of each other’s parents?

Medical advancements facilitate aging Americans’ longevity even with comorbidities such as high blood pressure, diabetes, kidney disease, atrial fibrillation, and other health issues. Hospitals can typically fix non-life-threatening conditions easily enough, but what happens when a parent is released to return home? Are you prepared? Is there a plan? Many adult children tend to practice avoidance, denial, and wishful thinking when thinking about their aging parents’ behalf in a potential medical crisis. It is advisable to organize and prepare for the changes that inevitably come to your parents’ health.

More than ever, seniors are choosing to live independently and with autonomy about their life decisions. Even if your parents are in a well-run continuing care retirement community, there will come a day when their health will force a change in their lifestyle and living arrangements. Many parents will resist “help,” which they may consider more as interference. Whether they believe they are being a burden to you or decline a geriatric care manager’s services due to “cost” concerns, most older people do not want others interfering in their private affairs.

The goal is to find a way to help while still affording your parents the dignity and respect they want and deserve. To achieve a comprehensive plan on your parents’ behalf, travel to them for an honest discussion. If this is not possible due to COVID-19 restrictions, then virtual meetings are best, followed by phone calls as hearing loss typically makes communicating useful information difficult. Even on a screen, a face-to-face connection allows a parent to read lips, which is a typical strategy for older people experiencing hearing loss.

Review what legal paperwork your parents have and make sure it is in order. Many documents have a signature from many years ago, and things may have changed. If there is no designation of a medical power of attorney, be sure there is a document naming a “personal representative” to address restrictions outlined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This document allows the waiving of privacy concerns that permit access to a parent’s medical information while the parent is in the hospital.

Create an up-to-date list of all your parents’ doctors. The list should include medical contact information and all medicines (prescription or otherwise) that the parents take. If their general physician is not a geriatric specialist, it will help to find them one. Post-hospital fog and newly prescribed medications from an adverse health event can create confusion in an older parent. A geriatric doctor will know to look for and resolve these types of issues. Ask about the parameters for health care intervention, such as dialysis, post-hospital during the time of COVID-19?

Explain to your parents that being released from a hospital for a non-life-threatening, yet serious health episode is usually followed by the need for a care manager, at-home nursing care, or at least companion care. This additional care should not fall to a spouse if the parents live together. A spouse has a unique role to fill as well as personal health challenges with which to contend. Heaping an increased responsibility for spousal health care upon them may be damaging to their health.

Before an unforeseen medical crisis can occur, identify several qualified agencies in your parents’ hometown. Review each agency and candidate carefully. It is easier to integrate a suitable candidate at the outset than having the chaos of retaining and releasing multiple workers. Remember that a candidate who works for one parent may not be another parent’s preference in the future. Maintain a strong relationship with the agency provider. They are an essential resource, and you will probably need them in the future.

Take the time to learn the specifics of your parents’ healthcare and living arrangements. Coordinating your plan of response is contingent upon whether your parents live independently, in assisted living, or in a retirement community. Wherever it is your parents live, their first desire will be to go home after an unexpected hospitalization. The desire to return home is a universal truth. Knowing the agencies that can quickly provide the type of care your parent needs in their home setting will go a long way to a successful transition. The road to recovery may require a few weeks of nurse visits, physical or occupational therapists, or simply companionship. The faster you can meet the need, the easier it will be on your parent.

If a full recovery is not possible, what will be your plan to address the new status of their normal? How much more medical oversight and assistance will they require? Know that in these instances, a parent can quickly spend through Medicare allotments afforded for temporary care. If they do not have long-term care, and many aging Americans do not, you will have to find ways to help them receive the care that they require.

If there are multiple adult children, is there an expectation that all siblings share information and work on the problems at hand, or is one in charge? Is this designation formally documented? Managing sibling relationships is key to avoiding family conflict. Also, understand your parents’ financial arrangements. Most parents will ask about the cost of any new healthcare service being arranged and decline to use it. It is hard for a parent to spend down the money they worked their entire life to amass.

Knowing your parents’ aging strategies will not address every issue you might encounter because they may not have all the necessary decisions and documents in order. You can only work within the authority they choose to provide. As attorneys, we can help identify gaps in their planning and recommend ways to fill those gaps so everyone can have peace of mind. We hope you found this article helpful. 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.

Family Caregivers Who Thrive

April 26, 2021Filed Under: Elder Law, Senior Health and Wellness

Around 17 percent of the US population is a family caregiver, and most are losing sleep, worrying, losing income, struggling to balance caregiving tasks with their workload and other family responsibilities. These 53 million caregivers are often experiencing ill health of their own and putting their well being at a lesser priority to their family loved one. The coronavirus pandemic further complicates matters as an October 2020 poll from The Associated Press-NORC Center for Public Affairs Research reveals that family caregivers provide 36 percent more care than one year ago due to the virus. Many family caregivers are exhausted, keeping their older loved ones safe and socially connected, often while working from home and supervising children during home school days. To be good to others, you must first be good to yourself. Making self-care a top priority allows you to be a more effective caregiver to your loved one. Here are ten strategies to implement today to ease family caregiver burnout.

Relentlessly add some “me time” into your schedule. There is time to enjoy life, visit (even if virtually) friends, read an enjoyable book, do some artwork, practice meditation, or just lay down and relax. Whatever it is that brings you joy and peace of mind (and it can be changeable!), put it in your schedule routinely.

Prioritize your healthcare. You cannot be an effective caregiver if you are unwell. It is a trap to spend all of your time managing your loved family member’s doctor appointments and medication while forgoing yours. When was your last checkup? Are you experiencing new symptoms under the stress of caregiving that you are not sharing with your doctor? Make those appointments for your well being today.

Eat a healthy diet and get enough exercise. Neglecting the very basics of a healthy lifestyle encourages health problems to present themselves in you. A healthy diet coupled with exercise will bring balance to your well-being, and from there, all things become possible. Ditch the fast food, drop the daily glass of alcohol, and practice a healthier lifestyle.

Connect with other caregivers. It is so helpful to address your caregiving frustrations out loud to others in a similar situation. You might find they experience similar feelings to your own. It is not a failure on a caregiver’s part to have these feelings. You are human and, as such, have frailties. Never try to be invincible. If you feel you need more help than this, seek professional counseling. A counselor can help you sort through the complexity of your situation and feelings, providing tools to navigate family caregiving’s complex emotions. Select a therapist who specializes in helping those who are caregivers and the associated dynamics.

Learn more about your loved one’s health condition to better prepare for what lies ahead. You can’t know the future, but a medical prognosis and additional research can go a long way to addressing uncertainty that increases stress levels. Understanding possible future scenarios will let you plan and reduce the number of surprises that can catch you off guard.

Learn to set boundaries and don’t let old family dynamics dominate today. As your aging loved one requires more care, your downtime can become non-existent. Stay true to your schedule and your needs. If your loved one requires more help, it is time to call in other family members for financial or hands-on assistance or hire a service to provide additional care. Also, do not fall into child mode and allow your parent to push your buttons as they may have in earlier years. Stay in the present and focus on the task at hand. If you find it hard to separate then and now behaviors with your parent, seek support groups or find a counselor to learn ways to combat falling into old patterns.

Get help and get it sooner than later. It is not your destiny to go through this alone. Talk to your family or your doctor to strategize about ways to reduce your workload and stress. Bring in professional care, even if just a couple of times a week for some relief. Ask for help and then accept it! Your family members may be willing to help financially and spend time remotely with your loved one while you take a well-deserved break. When someone steps in to help, do not hover or micro-manage the situation. Walk away and clear your head. The world will spin without you being the family caregiver for a few hours or even a few days. Do not delay. Take good care of yourself to be your best for others.

Make sure you have a plan. If something should happen to your health, have you put into writing who should make decisions for you, who should manage your affairs, and what your wishes are regarding your care? If not, the time couldn’t be better. We can help, and would welcome the opportunity to make sure your wishes are properly documented.

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

Is It Safe for Nursing Homes To Be Open?

August 29, 2020Filed Under: Elder Law, Long Term Care, Medicaid Planning, Senior Health and Wellness

Nurse consoling senior woman holding her hand

As many state officials now begin to ease current Covid-19 restrictions, the May 10th Wall Street Journal (WSJ) reports that the Centers for Medicare and Medicaid Services (CMS) is considering likewise for nursing-home residents and their families.

Since March 13, visitors and communal activities have been banned under CMS restrictions. WSJ obtained a leaked draft of CMS guidelines under which visitors might, at some future time, begin to be admitted to nursing homes. The guidelines reportedly set forth a phased procedure, in which elder facilities able to show lessened or no infection rates could allow group dining and activities, and small numbers of visitors during restricted hours, all with physical-distancing restrictions. It is not yet known when CMS will complete and release these contemplated guidelines.

Covid-19, the disease caused by the coronavirus, is particularly fatal at congregate facilities where the elderly live in a confined environment and are cared for by workers who move from room to room. Data gathered independently by the New York Times (NYT) show that “while just 11 percent of the country’s cases have occurred in long-term care facilities, deaths related to Covid-19 in these facilities account for more than a third of the country’s pandemic fatalities. In 14 states, the number of residents and workers who have died accounts for more than half of all deaths from the virus.”

NYT reporters fear, however, that their totals “almost certainly represent an undercount of the true toll.” Data on residential elder facilities are apparently difficult to obtain because some states release specific information on cases and deaths at specific locations, some states report cases but not deaths, and around a dozen states release very little or no information.

Testing is widely acknowledged to be an important tool in the recovery effort, yet WSJ quotes an expert who reckons that we are around four to six months away from widespread availability. The Infectious Diseases Society of America has published diagnostic guidelines on May 6, but these caution that there are still many unanswered questions. Some of the speedy tests can include false negatives, as to the initial infection, between around 15% and 30%. Click here for more information.

So people who show no symptoms and who have been “cleared” by the faster tests could be walking around thinking they are fine, yet shedding the virus and infecting others. And it is not yet known whether those who have ostensibly recovered from Covid-19 might, or might not, be immune and free to dispense with all precautions. It is crucial, then, that those in the community who might be allowed in to nursing homes should be cleared with the most sensitive test available – and even if so, they could have become infected after having been tested.

There is no telling when these concerns will be addressed with sufficient safety for CMS to release its elder-residence guidelines. Thus, for the moment, the challenge is ongoing to protect our vulnerable elders, many or most of whom are cut off from family and unhappy at having been isolated for more than two months by now.

If you have questions or would like to discuss your particular situation with us, please don’t hesitate to reach out.

Strategies to Help Cover the Cost of Assisted Living

July 31, 2020Filed Under: Medicaid Planning, Senior Health and Wellness

With the price of assisted living rent varying from $2,000 to $5,000 monthly, it’s important to understand the strategies available to help cover these high costs. There are many paths available to offset these costs and the right path for you will determine on the unique circumstances of your past life, current situation, and future wishes.

Depending on what type of care your loved one needs, assisted living can be the most affordable solution when compared to a nursing home ($5,000 to $10,000 or more per month) or long-term in-home care. If closely monitored medical supervision is not necessary for your aging senior, assisted living might be the best financial choice.

The Various Strategies Available to Cover the Cost of Assisted Living

One payment strategy that has become popular is to use Medicaid. If your loved one does not have many financial assets and their income levels are low, this could be the right solution for them. Medicaid varies from state to state both in name and in eligibility requirements. Many states dictate that a senior is eligible if he or she has less than $2,000 in assets, or $3,000 if married.

If you are trying to help a senior with a creative financial strategy by gifting money and other assets to family members, known as “Medicaid spend-down”, the government has a five-year look-back rule regarding financial transactions. There are strict guidelines about Medicaid spend-down. If a senior is caught incorrectly spending down resources to qualify for Medicaid, the penalties are steep, including disqualification from receiving Medicaid for a lengthy period. Also, many states do not cover assisted living under Medicaid, but require the submission of an additional wavier. Be aware that Medicaid assisted living payments are only accepted by some communities and Medicaid beds are usually limited. There can be long waiting lists to enter into a Medicaid financed assisted living facility.

If your senior has a disability, he or she may qualify for Supplemental Security Income (SSI), which is a federally administered program. SSI is the government safety net for those destitute and wholly or partially disabled by illness or injury. SSI is a monthly payment which a senior can use to pay for assisted living. To qualify for SSI, contact the appropriate local Social Security office and provide financial documentation and a doctor certification to attest to your senior’s inability to work because of a medical disability.

If your loved one or their spouse is a Veteran, residential care could be paid for in a variety of situations with Veterans benefits. There is a set of benefits available to those with disabilities or service-related injuries, and there is also another set of benefits called Aid and Attendance, made available to any Veteran or surviving spouse who is both disabled and whose income is below a certain threshold. The Veterans Administration website outlines the complicated process to access benefits. It is extremely beneficial to work with an elder law attorney who knows the details of the programs and can assist with the application.

A life insurance policy can pay for your loved one’s assisted living. Often, seniors have a long-standing policy that was implemented to help family members upon their death, but a life insurance policy can provide financial support now. A process known as “accelerated” or “living” benefits is a “cash out” policy that can have your senior redeem 50 to 75 percent of the face value of the policy. Each amount is based on specific policy conditions as well as individual corporate rules. Some policies can only be cashed out if the policyholder is terminally ill while other companies are more flexible in cash outs. If your senior’s particular company does not allow the policy to be cashed, it can still be sold to a third-party company who usually affords the same 50 to 75 percent face value cash out. That company continues to pay the original premiums until their death, at which time the company redeems the full value of the policy. Finally, if your loved one’s policy is of lesser value, it may qualify for a life settlement option known as a “life assurance” benefit or conversion program, which allows the senior to convert between 15 and 50 percent of the policy value directly into long-term care payments.

Does your loved one have a long-term care insurance policy? It can pay for assisted living care. Policies vary, but once the determination and action is taken to collect on it, those monies can be paid directly to an assisted living facility or to the beneficiary who in turn pays the facility. It is wise to consult with an elder law attorney to help understand individual company requirements to optimize the process of collection.

An annuity can be used to pay for some or all of the senior’s assisted living. If your loved one invests a lump sum into an annuity, they will receive regular payments over a promised time period, usually the rest of their life. The annuity helps to stretch your senior’s budget and guarantee at least some money is coming in, even in the event they live longer than expected. Most annuities allow the beneficiary to continue to receive money regularly even if the purchase premium runs out. If your senior were to live a very long time, they would get more back than they put in and an added bonus is that annuities are oftentimes not fully counted as assets by Medicaid when applying for government assistance. The income is counted but not the value of the asset. It is imperative to seek the advice of an elder law attorney before opting into an annuity as they are complex financial products and a wrong decision could be disastrous.

Reverse mortgages are another strategy to pay for assisted living. If your loved one owns their home outright or has only a small mortgage on it, they can get cash value from their home equity in a lump sum or series of monthly payments. The bank will decide the valuation of the home based on multiple factors like the homes worth, interest rates and the applicant’s age. The borrower can stay in the house until death even if the loan balance exceeds the worth of the home. After death, the loan balance has to be repaid which usually means selling the home. Reverse mortgages were developed to help widows remain in their homes after the primary income earner passed away or if that spouse needed to move into assisted living, leaving the other spouse to reside in the long-time family home. Like annuities, a reverse mortgage is a complex financial product, and it is crucial to receive sound advice from a trusted professional and work with a reputable reverse mortgage company. If only one senior parent is living and they do not want a reverse mortgage, they might consider renting out their home and using a landlord to manage the property. The income from renting the house can be used to pay for assisted living expenses.

Lastly, it is possible to pay for assisted living with a bridge loan, which is a short-term loan of up to $50,000 explicitly designed to provide funds to move a loved one into an assisted living facility or continuing care retirement community. It is an unsecured (no collateral required) line of credit with the intent to finance the first few months of living expenses during the sale of the senior’s home, while the application for Veterans benefits is pending, or other actions that are taken that free up funds. Since the interest rates can range from 8.25 to 12.5 percent, this option is best as a short-term strategy. The other type of bridge loan is called the Capital Access Program. It is a lower interest lump sum loan secured by real estate or other assets that the company deems acceptable collateral. It is designed to help seniors come up with the large upfront entrance fee some senior assisted living facilities require. Both types of loans are based on the usual credit criteria: credit score, credit history, debt to income ratio, and more. The senior or an adult child can secure the loan, and up to six family members can cosign loan applications, allowing the risk to be shared among multiple family members.

If your loved one is healthy enough to successfully live in an assisted living facility, the monthly cost is likely a top factor when considering their options. These are some, but not all of the viable and creative ways to pay these costs. To fully explore the options available and what is best for your senior seek the advice of an experienced elder law attorney and make the best decision for your loved one. Contact our office today and schedule an appointment to discuss how we can help you with your planning and which strategy is best to help your senior pay for assisted living.

If you have questions or need guidance in your planning or planning for a loved one, please do not hesitate to contact our office at (513) 771-2444.

Before a Medical Emergency Occurs, Learn About Your Parents’ Aging Strategies

Family Caregivers Who Thrive

Is It Safe for Nursing Homes To Be Open?

Strategies to Help Cover the Cost of Assisted Living

The Various Strategies Available to Cover the Cost of Assisted Living

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