Elder Care Law – What is Life Care Planning? Part 3

When we discuss Life Care Planning, we talk about the elder care continuum, which is a timeline on which the individual is moving toward the end of their life. The ideal for all of us is to age in place. That means the elder who lives in their own home, independently and successfully with no assistance needed, until they pass away. Some people have the good fortune to depart life in this manner, but many do not. Instead, they may have Alzheimer’s or Parkinson’s disease, or suffered a disabling stroke, or become frail, or otherwise have found themselves moving down the elder care continuum. They find that they need assistance with activities of daily living. That means they need to plan for their long-term care needs.

What does life care planning mean? I describe Life Care Planning as our discovering the elder’s place on the elder care continuum and then figuring out what we need to do to identify, access, and pay for good care for the individual, both now and in the future. That is not as easy as it sounds, but for an elder centered law practice, it is the essence of what we do. To put it another way, we help older people manage their chronic illnesses. Seniors need to get good care when and where they need it, and they need to know how to pay for it. As an elder centered law practice, we will include in our engagement agreements with the client a paragraph that says that we will not knowingly take a position that harms an elder and it is our goal to improve the quality of life for those elders we serve. By entering into this agreement with us, you expressly authorize us to act in your best interests at all times.

Our team consists of an Elder Law Attorney and an Elder Care Coordinator. What is an Elder Care Coordinator? An Elder Care Coordinator is a professional, who specializes in assisting older people and their families to attain the highest quality of life given their circumstances. An Elder Care Coordinator will:

o Help clients and families identify care problems and assist in solving them.
o Assist families in identifying and arranging in-home help or other services.
o Coordinate with medical and health providers.
o Provide support, guidance, and advocacy during a crisis.
o Help with coordinating transfer and transportation of an older person to or from a retirement complex, assisted care living facility, or nursing home.
o Provide education.
o Offer counseling and support.

As a part of the Life Care Plan, the Elder Care Coordinator helps seniors and their families with their long-term care concerns. Your Elder Care Coordinator functions as the point of contact for the family and assists in coordinating services to help you take care of your loved one.

Your Elder Care Coordinator has extensive knowledge about the costs, quality, and availability of resources in the community. As families begin their journey through the long-term care system, it is helpful for them to have a supportive and knowledgeable advocate to accompany them along the way.

An example from our practice will show you the importance of the Elder Care Coordinator. One of the duties of the Elder Care Coordinator is to visit our clients on a regular basis wherever they are living. During a recent visit to a nursing home to see one of our clients the Elder Care Coordinator noticed that a client was acting in a strange manner, not at all like they had in the past. She went to the nurse to see if they were aware of anything that would have caused a change in that individual’s behavior. She was told that there was nothing. She then contacted the family to see if they noticed anything unusual. Again nothing. But, she was persistent. To make a long story short, the Elder Care Coordinator was able to determine that the nursing home had two patients with the same exact name, residing on the same floor and they were both being taken care of by the same nurses. I am sure that by now you can guess what happened. Our client was given the medication that was supposed to go to the other individual with the same name. The Elder Care Coordinator sprung into action. She had the other individual moved to another floor where they would be taken care of by different nurses and arranged to change the way the names were recorded in the files and on its computer so that this mixup would not happen again. I can only imagine what would have happened if this would have been permitted to continue the way it was without the advocacy of the Elder Care Coordinator.

Life Care Planning is an innovative approach to elder law that helps families respond to all of the challenges presented by long life, illness and disability. Peace of mind for the elderly and their families is the goal of every Life Care Plan.

Michael D. Weinraub, Esq., CELA, is Certified as an Elder Law Attorney by the A.B.A. approved National Elder Law Foundation.

Michael D. Weinraub, P.C. is a holistic elder law practice that helps families plan for, pay for, and coordinate the long-term care of elderly loved ones. We work with senior citizens and their families who are overwhelmed or confused by all of the decisions they have to make planning for the future. Our practice involves the use of a Life Care Plan. The Life Care Plan places special emphasis on issues surrounding a long life. The Life Care Plan connects your concerns about long-term care as you go through the later stages of your life with the knowledge and expertise of an Elder Law Attorney and an Elder Care Coordinator who will be with you eve

Posted in Uncategorized | Tagged , | Comments Off

The Changing Face of Elder Care

There was a time when Mom became too frail to take care of herself the only option was “the old folks home”. Now our choices have much improved. We have independent living facilities, assisted living facilities, skilled nursing facilities and nursing homes. Many of these have the look, feel and amenities of a resort. In fact many of them refer to themselves as “retirement resorts”.

They are really nice but some can be real pricey too. But for the aging loved one who desires to stay in their home, the home where they feel safe surrounded by neighbors who they trust and in the home of memories we now have in home senior care.

Senior care or elder care includes a wide range of services that are provided over an extended period of time to people who need help to perform normal activities of daily living because of cognitive impairment or loss of muscular strength or control.

Elder care can include rehabilitative therapies, skilled nursing care, palliative care through hospice, and social services, as well as supervision and a wide range of supportive personal care provided by family caregivers and/or home health care agencies. Elder care may also include training to help older people adjust to or overcome many of the limitations that often come with aging. If appropriate, elder care can at best be provided in the home first.

Where do we start when looking for resources for elder care for a loved one? Resources that can help the elderly stay in their own home are the first place to start. A variety of independent living services are now available to help the elderly care for themselves in their own home despite their changing physical needs. This may help, delay or totally avoid moving into an assisted living or nursing home.

Resources for Elder Care that can help the elderly stay in their own home:

The following are just a few of the national resources available and a good place to start. It would be more helpful for you if you did a computer search on Google or bing using these national names tied to your location. For instance “American Society on Aging Peoria AZ”.

A.A.R.P. (formally The American Association for Retired Persons) is the largest organization for adults age 50 and older. There is a part of the website which offers many resources for housing and mobility options for elderly care living.

Visiting Angels is non-medical in home elderly care service provider and elder care living assistance service. Visiting Angels offers a variety of customized services to help the elderly stay in their own home. Visiting Angels are elderly care specialists.

American Society on Aging – The American Society on Aging is a nonprofit organization committed to enhancing the knowledge and skills of those working with older adults and their families. This site offers useful resources on a variety of aging-related and elder care topics and elderly care advice.

Elder web – This site is designed for both professionals and family members looking for information on elder care and long term care, and includes links to information on legal, financial, medical, and housing issues, as well as policy, research, and statistics.

National Resource Center on Supportive Housing and Home Modification – NRCSHHM is a non-profit organization that promotes aging in place and independent living for persons of all ages and abilities. The website contains excellent resources on senior housing, elder care and home modifications.

By using resources available, elderly care in the home becomes a viable option. Elder care does not have to mean you have to do it alone. Becoming knowledgeable about elderly care issues make the aging transition an easier road to go down.

Michael Simpson is Director of Visiting Angels in NW Phoenix. They are a home care company providing no

Posted in Uncategorized | Tagged , , | Comments Off

Recognizing Elder Care Abuse

There are more than half a million reports of elder abuse in the United States every year according to state Adult Protective Service data. Some studies show that only 1 in 14 cases of elder abuse are even reported to authorities. Impacts can be grave because elders who experience abuse are reported to have a 300% higher risk of death compared to those who do not experience abuse. Often, elderly adults are abused in their own homes and by their own relatives. Elder care abuse is a growing area of focus today and, as a provider of home health care services in Maryland, we believe it is important to educate those who are either receiving, or thinking about seeking, senior care to be able to recognize the signs.

One of the most disturbing aspects of elder care abuse is that it almost always involves a trusted relationship with the elderly person. Overwhelmed family caregivers can sometimes reach a breaking point and become neglectful in their duties or, even worse, begin preying on the very people they have pledged to support. In order to report elder care abuse, families first need to be able to identify the various types and warning signs.

Emotional abuse

This occurs when people treat elderly persons in ways that cause emotional pain or distress.

Sexual abuse

Sexual abuse against elderly persons is contact without the elder’s consent. This can involve physical sex acts and also showing them pornographic material, forcing them to watch sex acts, or forcing the elder to undress.

Neglect or abandonment by caregivers

Elder neglect, which is the failure to fulfill a caretaker obligation, represents more than 50% of all reported cases of elder abuse. Both intentional and unintentional neglect can be based on factors such as ignorance or denial that a patient requires a particular level of care.

Financial exploitation

Unauthorized use of an elder’s funds or property, resulting from misuse of their checking or credit card accounts, stealing cash or goods, forging an elder’s signature or stealing their identity.

Healthcare fraud and abuse

This is considered unethical treatment by doctors, nurses, hospital personnel, and other professional care providers such as charging for healthcare services but not providing it, overcharging for services, over-medicating or under-medicating an elder, getting kickbacks for referrals and Medicaid fraud.

There are several ways to spot these different types of elder abuse. For example, tension or arguments between the elderly person and their caregiver or changes in the elder’s personality or behavior. Unexplained bruises, welts, especially if they occur symmetrically on two sides of the body, broken bones, sprains, medication overdoses, broken glasses, signs of restraint such as marks on wrists and a caregiver’s refusal to allow family members to see an elder alone are all telltale signs of abuse.

There are several things you can do as a concerned friend or family member to help those who may be experiencing elder care abuse. Monitor the elder’s medications and ensure that the amount corresponds to the date of the prescription. Watch out for financial abuse by asking elders if you may see their bank accounts and credit card statements to review them for any unauthorized transactions. Try to call or visit elders as often as possible so that they know they have a trusted person they can confide in. Also, it’s a good idea to make offers to stay with elders so that caregivers can have a break if at all possible. And, of course, the most important thing you can do is to report any suspected abuse to the proper authorities.

Posted in Uncategorized | Tagged , , | Comments Off

Home Health Care Vs Facility Placement – Options in Elder Care

It always makes me sad to hear the families of an elder say “Mom made me promise to never put her in a nursing home”. That is simply a promise that most families today cannot keep. If a caring son or daughter finds that they have to break that promise, they may feel guilty for the rest of their lives. Mom probably asked for that promise because the nursing homes she remembers were dark, institutional places which would be considered substandard in America today. Today’s family structure and the financial challenges of elder care, make facility living a very common choice. When an elder shows signs of not being able to perform the basic activities of daily living, families or concerned professionals must step in. It is actually against most state laws for a professional to be aware of an elder in trouble without taking some reasonable action to secure their safety. There are many indicators that an elder is no longer safe at home alone. The basic litmus test is to ask yourself is: “Could this person save him or herself if their home were on fire? Would they be able to call 911 and communicate their exact location? If left alone for any period of time are they at risk for physical abuse or financial exploitation? Do they have the skills and resources to meet their daily hygiene and nutritional needs? The answer is “NO” for many American elders who live home alone.

Independence vs. Isolation

Many of my elderly clients who were trying so hard to maintain their independence by living alone at home actually maintained nothing more than an isolated existence punctuated by the occasionally call or visit from friends and family. This type of isolation was also coupled with medication errors or abuse, self neglect and unsanitary housekeeping. A person living in this situation will often “bloom like a flower” in the right retirement facility environment. It is amazing what three hot meals a days, social interaction, clean sheets and regular administration of medications can do for a person’s mind, body and spirit. A person who lives alone is more likely to fall and lay alone on the floor for days without being found. A person, who lives alone may make poor choices such as keeping, (or worse,) spoiled food in the refrigerator. If a person lives alone, there are many signs of illness that no one will notice during sporadic short visits. Medical appointments may be missed and prescriptions left unfilled. Many people feel that they are honoring their aging loved one by letting them live alone, even though all the tell tale signs of self neglect are apparent. There is no honor or dignity in being found on the floor after one has laid in their own excrement for three days. Unfortunately, many families will wait for this type of incident before insisting on either home health care or facility placement. If an elder is physically or verbally abusive to family and care givers, they are much more likely to be left alone to make their own decisions, regardless of how dysfunctional their situation may be. Elders with difficult personalities are many times more likely to be abused by caregivers. They need more supervision, not less.

American Family Dynamics and the Pressures of Today’s World

I hear people say “Americans don’t take care of their elders like other countries do”. Well that is not my experience. The adult children who consult with Geriatric Care Manager or other eldercare professionals are very concerned about their parents. They love them and they want the best care their money can buy. That’s the clincher: what their money can buy. In America, caregivers, maids, etc,, are expensive. Perhaps in another country where slave labor is commonplace, people can afford plenty of care. But in this country it costs $12.00 per hour (or more) for a home health aide. At eight hours per day, that is $96.00 per day. That is $2,880 per month or $34,560 per year – more than the average working American earns per year. The average woman gets a social security check of less than $500.00 per month. Do the math and you will soon see that unless you are wealthy, many people cannot afford to keep their elders in their own home with a part time caregiver or even in their children’s home with a caregiver.

Now couple this financial problem with another very real problem. Most middle income women in their fifties, who are caring for their elderly parents, are also trying to hold down a job, help their young-adult children and maintain a marriage. If a middle income woman stops working to care for her parents, she and her husband either cannot pay their bills or they must significantly reduce their standard of living. I know a few husbands who are fifty-something and feel they have worked too hard and too long to have their dreams of retirement evaporate because someone else’s needs are suddenly more important than their own. Now that Americans have come to grips with the concept that it takes two incomes to live well in this country, they are more determined than ever to have a retirement. Paying $35,000 per year for a caregiver can take a huge chunk out of the retirement savings. Frankly, most people couldn’t afford to do it even if they wanted to. Because most Americans’ net worth is in the equity of their home, selling the family home is the most common way to finance elder care services. If the family home sells for $100,000.00 and the average cost of an Assisted Living Residence is $36,000.00 per year, an elder can afford to live in that Assisted Living for 2.7 years. Coincidently, the average amount of time a person lives in an Assisted Living before moving on to a nursing home is 2.5 years.

Many adult children, who do have the desire and financial means to bring their elders to live with them, still cannot. They cannot because the medical or psychological needs of the elder are beyond their capacity to manage. For example, if Grandma is sweet and docile by day, but “sundowns” or grows agitated as evening falls, this poses a difficult problem for the caring family. When some people experience dementia or other medical issues, they may stay awake all night. They sometimes wander out of doors or rummage through drawers and closets. This behavior will keep the whole family awake at night. If a working family cannot sleep at night, this situation will become intolerable very quickly. Some adult children have been raised by violent, aggressive parents who are now violent aggressive elders. Children who have been raised under these conditions need not feel obligated to bring their parents to live with them, despite the pressure they may get from outsiders who do not know the real story.

Elders and their families who are trying to make difficult choices about elder care benefit from a professional assessment from a geriatric specialist. Professional care managers can offer an objective opinion based on a clinical evaluation of the physical and cognitive status of the elder. Physicians, hospital case managers, facility admissions coordinators and social workers can also offer advice about appropriate placement of an elder or even suggest how to set up services in the home to best meet the elder’s needs.

Home Health Care – Stay Home without Being Alone

At the very least, any elder living alone should have a medical alert system. This is a necklace or wrist band with a panic button that can be pushed in case of emergency. If the button is pushed a dispatch center receives the signal and makes and attempt to communicate with the elder through a speaker placed in the home. If the elder needs help or does not respond to attempts to communicate, emergency services will be dispatched to the home. Many services will also contact friends and family to notify them that assistance is needed. A good candidate for this device is one WHO DOES NOT have memory loss as memory loss makes it difficult to learn to operate new appliances.

There are two basic types of home health care services: Medicare and Private Duty:

Medicare Home Health is free but can only be accessed if ordered a physician. Medicare will only authorize the free home health services if specific events have happened such as a recent hospitalization lasting three or more days, or a recent change in health status, etc. Medicare will send a Registered Nurse to evaluate the elder and that nurse decides if other professionals such as physical therapists, social workers, dieticians, etc. should perform evaluations. Each professional will determine what services they will render and for how long. Medicare services are temporary in nature and are not offered on a full time basis. The average visit by the nurse, aide and therapist is less than one hour each. Even Medicare home health aides only stay long enough to bathe and dress the patient.

Private Duty Home Health can be arranged on a full time, part time or live- in basis. Many Long Term Care Insurance policies will pay for home health care. The amount of care one can get and the duration of the services varies depending upon which policy they purchased. If someone does not have insurance, they must pay out of pocket (or private pay) for any services. Typically a private home care agency will offer services at a minimum of four hours per day. Typical eight hour shifts are 7am-3pm, 3pm-11pm and 11pm – 7am. Many elders complain that an agency sends them a different caregiver each day. In order to avoid having the same aide, that as much as possible, order care every day for at least eight hours. This will allow the agency to schedule the same person for all your shifts. Because labor laws do apply and the agency would have to pay overtime for time which exceeds 40 hours per week, you will most likely have at least two to three caregivers on a full time case. The average hourly rate is $14.00 per hour. A live-in will cost about $150.00 per day. A live-in lives in your home and drives your car (or theirs for a mileage fee) and you are expected to feed them as well, even if you go out to dinner. By law, a live- in is entitled to two hours per day of free time. They can do what ever they like, including leaving the house during their break. If this arrangement will not work for your situation, consider hiring an aide around the clock. Around the clock care is typically delivered in two twelve hour shifts which are done by two different caregivers.

One aide comes to the home from 8am until 8pm and is relieved by the second caregiver at 8pm until 8am. Around the clock care can be delivered in many schedule formats. A live- in is expected to have their own private bedroom and bathroom although many agencies are flexible on this issue. The live- in is expected to be awake all day and have at least 7 hours of sleep at night. If the elder does not sleep at night, a live- in arrangement will not work. One option is to have the live in ($150/day) plus hire a caregiver to come to the house and stay up all night with the elder ($14.00. hour for eight nighttime hours). This costs $112 + $150= $262.00 per day. The only other alternative is to have around- the- clock care which will cost $14.00/hr X 24 hr=$336/day. Adding the eight hour night shift to the live in, saves about $3,000 per month. The Veterans Aid and Attendance Pension is available to qualified veterans who need a caregiver in their home on a regular basis.

Types of Adult Housing and Facilities:

Independent Living Facilities usually offer small apartments with some meals included in the price. A person who lives in an Independent Living Facility is expected to manage their daily care needs on their own, but the staff would readily recognize if needs increased and assist the resident in obtaining the needed help. Some facilities have extra care services available for additional charge to help the resident “age in place.” Others may ask a resident to move out if their needs exceed the scope of that particular facility. Limited transportation is usually provided although many residents are still driving when they enter an Independent Living Facility. These facilities may cost anywhere from less than $1,000 per month to over $5,000 per month depending upon the luxury amenities and location.

Assisted Living Facilities usually offer hotel size rooms with the option to share a room or pay extra for a private room. Three meals and snacks are usually provided as part of the price. Residents are expected to need some assistance with their daily care needs. Medication administration is strictly supervised. The State laws dictate who can live in an Assisted Living. The State does not want Assisted Living facilities to house nursing home candidates or Nursing Homes to admit people who could function just as well in an Assisted Living Facility. Assisted Living residents must be able to walk and transfer ( from bed to chair or chair to standing) with the assistance of only one other person. An Assisted Living resident can be left alone in their room for two hours or more. Nurses aides are on duty around the clock. Registered nurses or Licensed Practical Nurses are on duty at least during the daytime. Many medical services may make rounds and visit residents at least monthly. It is not uncommon for an Assisted Living resident to never have to leave the building for a medical or beauty appointment. Prices may range from under $1200/month to over $8,000/ month, once again depending upon the amenities. Medicaid has a program called the Medicaid Waiver which can pay part of the cost of the Assisted Living. However, funds have been historically limited and waiting lists can be long. The Veteran Aide and Attendance Pension is designed to financially assist qualified veterans who need the services of an Assisted Living facility

Dementia Specific Facilities are designed especially for the memory impaired resident. The building, floorplan, furnishings, d├ęcor, activity program and even the lighting have been scientifically engineered to enhance the lifestyle of residents with dementia. Many Assisted Living Facilities and Nursing Homes offer a dementia program or dementia unit, but there are entire facilities which specialize in this unique population. Dementia Specific Facilities can be either Assisted Living Facilities or Nursing Homes. They are secure in order to prevent residents from wandering off the property and getting hurt or lost. The price for this extra level of care is usually about $1,000 to $2,000 more per month than a non-specialty building.

Nursing Homes are State regulated and are inspected at least annually. A person who needs a nursing home generally cannot live safely in an Assisted Living environment. A typical resident is either wheelchair bound or bed bound. Those who can walk around freely may need the nursing home environment because they need constant medical supervision. The medical component of this environment is similar to a hospital or hospice setting. The emphasis is on rehabilitation or custodial care rather than socialization and activities. The ICP Medicaid Program (institutional care program) will pay for the room, board and medical costs of those residents who meet the financial and medical criteria. It is possible to plan in advance to help an elder meet these strict criterion.

Financial Realities

Keeping an elder at home with a caregiver can be the most expensive option of all. Many families feel keeping their loved one in the comfort of their own home is priceless. If a paid caregiver cost $14.00/hour, eight hours per day is equal to $2,880.00 per month. Around the clock care exceeds $10,000 per month. Independent Living Facilities cost an average of $2,300.00/ month and provide no personal assistance. Assisted Living Facilities range from about $2,500/month to $5,000/month and provide limited care. A Nursing Home (without ICP Medicaid assistance) can cost from 5,000.00 to $7,000.00 per month and will provide total care.

Anyone considering hiring home health or moving an elder into a care facility of any type should have their elder’s current needs assessed by a qualified professional who can ascertain the elder’s current medical/psychological and financial needs and anticipate future needs/solutions. With careful, realistic planning, caring for an elder does not have to be a financial or emotional nightmare. Making the right choices for you and the elder you care about is easier when you enlist the help of people who know the eldercare community and all that it has to offer.

Posted in Uncategorized | Tagged , | Comments Off