Snow Means Special Challenges for Seniors, Nursing Homes in NJ

The year’s first snowfall is always an exciting thing, but a little goes a long way. Here in New Jersey, of course, we get more than just a little.

For our state’s senior population, substantial snowfall can be a serious concern, and not just because of the cold weather. When blizzards become emergencies, issues like transportation, evacuation, and access to healthcare present true urgencies for the elderly.

A recent New York Times article describes the turmoil that a Buffalo, NY nursing home is enduring during the most recent snowstorm, which is responsible for more than a dozen deaths. Among those killed is a 92-year-old resident at Garden Gate Health Care Facility, though the circumstances of her death (and the role that snowfall played) remain unclear.

It was Hurricane Sandy that taught nursing homes nationwide to take emergency evacuation plans seriously. Many elderly and mentally disabled patients along coastal New Jersey and New York were stranded.

But even with an evacuation plan in place, the unforeseeable can still arise. That’s what happened in Buffalo, where the nursing home was surprised to find its structural integrity in question thanks to several feet of snow. A nearby warehouse had already collapsed. The available solutions all seemed like a challenge.

Of course, evacuations are never easy. That’s especially true when frail seniors with pressing healthcare needs are involved.

As the winter months press on, it’s important to keep calm but also to have a plan in place for your family. Talk with your loved ones’ nursing homes or assisted living facilities. Are they prepared for sudden winter emergencies? Do you know where your family members will go or how they’ll get there?

If you have questions about senior care and winter-weather preparedness, a New Jersey elder law attorney can help. Feel free to give us a call to talk about your concerns.

Posted in Assisted Living, Elder Care, Family, Nursing Home, Seniors | Leave a comment

Why the Holidays are the Perfect Time to Update an Estate Plan

We all know the holidays are the right time for sleigh riding, bell ringing, and tree trimming… but what about estate planning?

The Pittsburgh Post-Gazette recently suggested something I like to remind my clients of as well: the holidays truly are the perfect time to update an estate plan.

Why? Two reasons, really: togetherness and timing.

The holiday season seems to bring with it an endless parade of family functions and gatherings. Some of us may see more of our families during the last two to three months of the year than we do in the others combined.

It’s a good time, then, to have important conversations about changes in assets, liabilities, and plans for the future. Having the whole family nearby can make it easier to square things away.

If you haven’t already, you should talk with the adults in your family (especially any parents and/or the elderly) about the current status of their estate plans. Do they have all the necessary documents in place? At a minimum, an estate plan should include a will, a power of attorney, healthcare directives, and in most cases, one or more trusts.

And because the holidays come at the end of the year, they also present a prime opportunity to think about your tax planning, both for next year and for the final quarter of 2014 (before it runs out).

If you or your family members have questions about estate documents, tax planning, or elder care, don’t hesitate to give my office a call. I’m here to help, even as all our lives get especially busy this time of year. I’m just a phone call or a quick office visit away.

Happy holidays, everyone!

Posted in Estate Planning, Family, Family Wealth Planning, Taxes | Leave a comment

Medicaid Facilities Are Like Hotels in More Ways Than One

Sometimes elder care feels a little bit like booking a hotel room.

As one of the world’s most widely recognized travel organizations, AAA offers discounted rates at big-name hotels all across the U.S. If you’re a member, you might be able to knock 10 to 15% off the rack rate.

But those savings aren’t always available in every room. Some hotels might block off a limited number of rooms and designate those as discount-eligible (whether for AAA or any other discount program). Accordingly, you might show up at the hotel without a reservation and find that all the eligible rooms are already gone. You’ll have to pay full price instead.

Medicaid facilities can work the same way.

I started thinking about the AAA analogy after seeing an article by the Houston Chronicle online. It describes the difficulties some seniors have when trying to use Medicaid in a purportedly Medicaid-accepting facility.

That’s because some such facilities advertise themselves as “Medicaid-accepting” but, in reality, reserve only a limited number of beds for Medicaid patients. The remaining residents have to pay full price… just like with those non-discounted hotel rooms.

Unfortunately, some elderly patients enter these facilities with the expectation of enjoying long-term Medicaid care there, only to later learn that all the Medicaid spots are already taken — perhaps after the family has already paid the facility a substantial sum.

One way to head off a problem like that is to ask probing questions of the facility before putting any money down. Find out exactly how many Medicaid-eligible beds are available and what the occupancy rates look like.

Another option is to work with an experienced elder law attorney from the get-go. At my office, we help elderly people and their families foresee potential contingencies like these and work toward a more effective solution.

If you have any questions whatsoever about accessing senior care facilities in New Jersey using Medicare or Medicaid, please feel free to give me a call.

Posted in Elder Law, Medicaid Planning, Nursing Home | Leave a comment

Nursing Home Life: More ‘Mean Girls’ Than “Golden Girls”?

“You can’t sit with us.”

The classic line from 2004’s Mean Girls movie perfectly embodied just how cliquey and cruel high school life can be in the modern age. The film’s characters carped at each other over everything from boyfriends and girlfriends to fashion and cafeteria seating choices.

But is nursing home life much different from high school?

That question came to mind as I read The New York Times’ recent entry on “nursing home style.” In it, a woman describes her thought pattern as she takes her elderly mother shopping. They were putting together a wardrobe to make a good impression at a new nursing home — an experience she likens to the first day at a new school.

“I want Ma to fit in,” the columnist writes. “I want her to be popular. I want her clothes to be right.”

“Are there mean girls in nursing homes?” she asks. “After a touring a few, I would say yes.”

Of course, residents in nursing homes or assisted living facilities have the benefit of experience and maturity… something Lindsay Lohan’s Mean Girls gals could have used more of. But the truth is that fashion, style, and social skills matter in almost every context… and at any age.

When picking the right community for you or your parents, it’s important to keep personalities and social atmospheres in mind. Some homes may make a better fit than others. And speaking of a good fit, a few new outfits can always help to lift the spirit.

Posted in Assisted Living, Elder Care, Family, Nursing Home, Seniors | Leave a comment

Maybe the “New Old Age” Isn’t a Good Thing After All

We hear a lot about the “new old age.” As advances in medical science allow people to live longer than ever — and healthily so — we’ve all had to reorient the way we think about “old.”

Many of today’s elderly can work and run and even revel with the best (and youngest) of them… but should they?

Baby boomers’ prolonged vitality is so often celebrated that maybe we’ve never paused to ponder whether an active old-age lifestyle is as freeing as it’s made out to be. But a Wall Street Journal writer is doing just that. Out with the new old age, he says, and in with the way it used to be.

“The ancients,” he insists, “had it right.”

In his mid-70s himself, Daniel Klein has determined that old age was always intended as “a unique and invaluable stage of life,” one that people might miss out on if they opt to stay in the rat race.

If Klein has you questioning your own approach to aging, you aren’t alone. It’s hard to know whether “liveliness” or “leisure” is the more rewarding pursuit in the latter stages of life.

Maybe balance is the key. A little activity here, a little rumination there. Of course, individual personalities and temperaments matter too. What seems stressful to me might feel therapeutic for you. We all find energy and inspiration in different and surprising places.

Klein is to be commended for recognizing that the dominant trend among baby boomers — that is, staying ever active, bustling, and busy — simply isn’t for him. At seventy-something, the man’s earned the right to live life as he pleases.

Let’s hope we all approach our own next stages with the same candor and self-respect, whether it finds us running a race or rocking a chair.

Posted in Baby Boomers, Retirement, Seniors | Leave a comment

How Strokes Could Unlock the Cure for Dementia

Stroke and dementia are fears we all face, especially in older age. The thought of encountering both in a lifetime is unsettling to say the least. And yet a new report finds that the combo is more common than we ever realized.

(Photo Credit: en.wikipedia.org)

(Photo Credit: en.wikipedia.org)

There are nearly 8 million new cases of dementia every year, but despite its prevalence, the cause has largely eluded medical science… until now.

A new study by the Krembil Neuroscience Centre in Toronto concludes that a common kind of dementia is actually caused by numerous, imperceptible strokes that occur over the course of time.

That might not sound like good news — “stroke” never does — but in terms of prevention, it might be.

Dementia is so cruel precisely because it is so unrelenting and untreatable. But prevention might be possible now that we know that tiny strokes may be to blame.

If doctors can detect that kind of vascular activity early on, even before any symptoms show up, they may be able to head off dementia using the same course of preventative action that they currently prescribe to potentially stroke-prone patients.

It’s an encouraging peek into what the next few years of medical science could mean for America’s elderly, not to mention a good reason to take vascular health seriously now.

Posted in Alzheimer's, Dementia | Leave a comment

Estate Planning Attorneys Are Humans Too… Or Should Be

It’s no secret that lawyers have a reputation for being “sharky.” In fact, a lot of us came up through law school at a time when the legal field tried very hard to fight back against that stereotype — an effort that continues even now. As a result, many of today’s attorneys are actually determined for decency.

(Photo credit: commons.wikimedia.org)

(Photo credit: commons.wikimedia.org)

I recently came across two different articles in major publications about the undeniably human impact that estate planning attorneys can have on their clients.

First, Forbes ran an article about the shift in what today’s clients look for in an estate plan. “What [people] really worry about,” the author writes, “is how the money they leave will affect the lives of those who will inherit it.”

Then I saw a New York Times piece called “Estate Planning with the Human Element,” in which one attorney started worrying that he’d focused too much on assets during his career, and not enough on the people he’s served.

Both publications focused primarily on enormous trust funds left to kids too immature to handle their spoils. Forbes imagined a “trust-fund baby” in rehab; New York Times recounted the tale of a young woman in a casino, writing checks that her parents’ fund couldn’t cash. In both cases, the attorneys — and the parents setting up the trust — have to step back and ask whose interests are really being served.

Of course, while both these articles look narrowly at trust fund abuse, the truth is that attorneys’ ethical obligations extend to virtually every aspect of estate planning.

I remind myself every day that the work I do may very well impact whole generations of lives. That’s why personal service — attorney to client — is so important in the practice of elder and estate law.

As modern-day attorneys, we want our clients to know that we’re human. Maybe the best way to demonstrate that is for us to remember that our clients — and their beneficiaries — are real people too.

Posted in Estate Planning, Family, Family Wealth Planning, Inheritance, Trusts | Leave a comment

Caregivers of the Future

When A.I. was released, the movie was met with generally favorable reviews. I liked it, but the movie seemed to be two different films in one. The middle part was an adventure story about a robot seeking to be a human and all the struggles that a future Pinocchio might face. The beginning and the end were more about defining what human is, and the meaning of relationships.

I always liked the beginning-ending story better. Much of it is effectively heart-breaking as we watch a family try and replace a lost child with a robot in the beginning, and in the end watch that robot-child define the “perfect day” as one filled with spending time with another person, his human mother.

I couldn’t get that movie out of my head as I read The Future of Robot Caregivers from the NY Times. The article discusses whether the difficult job of caregiving can be done by robots.

As I meet with elders and their children, I watch them all struggle with providing this kind of care and companionship. Sometimes they face being far away, or having limited means, or having a senior with particularly challenging care needs. Not all of them can avoid having the senior spend lots of time alone.

The comedian Louis C.K. has a bit (as comics call a comedy sketch) about how the reason why we are so attached to our phones, and texting, and sending stuff on Facebook is that we are terrified about being alone. One of his points is that we should get more comfortable being alone and being scared about being alone.

Perhaps robot caregivers is a partial solution, perhaps not, but seniors shouldn’t have to be lonely in their old age. Providing that companionship is a matter of respect and dignity and they’ve earned both.

Posted by Victor Medina, Medina Law Group, LLC

Posted in Alzheimer's, Dementia | Leave a comment

What Do Nursing Homes Actually Cost?

What Do Nursing Homes and Assisted Living Facilities Actually Cost?

Most of the planning we do in the elder law area is to help seniors afford the care they need so they don’t run out of money or options before they run out of breath. One of the common questions is: What does long-term care really cost?

I found this link from New York Life that gives the average cost for nursing homes, assisted living facilities, and home health care providers — such as registered nurses (RNs), licensed nurse practitioners, and home health aides. You can look up your specific metropolitan area, but I’ve listed the numbers for my area in central New Jersey here below:

Cost of Long Term Care In Central New Jersey

Cost of Care Type of Care
$12,931 Skilled Nursing Facility – Private Room Monthly Rate
$11,746 Skilled Nursing Facility – Semi-Private Room Monthly Rate
$6,393 Assisted Living Facility – One Bedroom Monthly Rate
$4,995 Assisted Living Facility – Studio Monthly Rate
$77.03 Registered Nurse – Hourly Rate
$22.45 Home Health Aide – Hourly Rate

Another article, found here takes the information from the New York Life study and ranks the various metropolitan areas. The rankings came out like this:

Top Most Expensive Areas For Nursing Home Private Rooms (Annual Cost)

Rank Cost of Care Metropolitan Area
1 $159,359 Fairfield County, Connecticut
2 $156,950 Anchorage, Alaska
3 $155,180 Metropolitan NYC, Long Island, Northern/Central Jersey

There are 25 metropolitan areas listed, but I was floored to learn that Medina Law Group is located in the third most expensive area for nursing home care. That’s simply incredible.

Posted by Victor Medina, Medina Law Group, LLC

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The Risks Of Giving Your Home To Your Children

Some parents consider transferring ownership of their homes to their children. Why? Many believe that it is a classic win-win situation. They can continue to live in the house, while at the same time reduce the value of their estate for tax purposes and provide a valuable asset to their kids down the road.

If you are considering such a transfer, an article in the Wall Street Journal explains why you should think long and hard before doing so. Here are a few factors to consider.

Loss of security
What if one of your children gets divorced and the ex-spouse decides to make a claim on the home? Or let’s say one of your kids loses a lawsuit, or defaults on a loan? In that case, creditors could make a claim on the home—you and your spouse might very well be evicted. Not exactly the way you had hoped to spend your golden years.

Medicaid ineligibility
If you apply for Medicaid assistance to pay for long-term care within five years of transferring ownership of your home, your application will probably be denied. Why? Medicaid has what is called a five-year look-back period for gifting. You could be ineligible for Medicaid assistance for years, depending on the length of time between your transfer of ownership and your application for benefits. Given the cost of long-term care, this could be financially devastating for you and your spouse.

Loss of reverse mortgage option
While reverse mortgages are not for everyone, in certain situations, they can be effective wealth preservation tools. Transferring ownership of your home to your children eliminates this option.

Are there any situations when transferring ownership of your home to your children makes sense? Some, particularly for families with sizable estates and the transfer would reduce estate value to an amount where estate taxes are minimized or eliminated. However, if you plan to live in the home after transferring ownership, it is advisable to take additional legal steps to protect your interests. These include life estates, qualified personal residence trusts, defective grantor trusts, and more. Contact our New Jersey estate planning lawyers to learn more about these options.

Posted in Asset Distribution, Estate Planning, Estate Tax, Family, Medicaid Planning, Reverse Mortgages | Leave a comment