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Why We Fail to Plan for Long Term Care

Most either don’t know, or refuse to accept, the facts surrounding the potential need for long-term care—not to mention the exorbitant cost associated with it.  This was reconfirmed recently in a telephone survey of 1,735 Americans over the age of 40, funded by the SCAN Foundation and conducted by the AP–NORC Center for Public Affairs Research.   This survey highlights many common misconceptions about long-term care, including the potential that a loved one may need some sort of long-term care within the next 5 years; lack of understanding of who will pay for care (Medicare? Medicaid? Private insurance?); and an increased lack of concern over failure to plan for the costs associated with long-term care.

Who Will Need Long-Term Care

According to the latest Genworth Cost of Care Survey, 70% of Americans over the age of 65 will eventually need some type of long-term care.  By the year 2040, 22% of the population will be over the age of 65—a 10% increase since the year 2000.  Even so, an increasing number of Americans over 40 refuse to believe they will ever need long-term care.

Cost of Care

Most people have no idea who actually pays for long-term care.  The truth is that Medicare does not pay for ongoing long-term care (although it will pay for intermittent rehab stays in a nursing home). 

As for private insurance, most health insurance plans will not cover long-term services like a nursing home, or ongoing care provided at home by a licensed home health care aide.  Yet, the survey revealed that 18% of Americans age 40 and older believe that their insurance will cover nursing home care, while 25%  believe their plan will pay for ongoing care at home.

Medicaid is the largest payer of long-term care services.   Medicaid is a federally and state funded needs-based benefit that will provide for various types of long-term care depending on the state’s regulations.  In 2013, Medicaid paid for 51% of the national long-term care bill, and as much as 66% of such costs in Alabama.  Despite those figures, 51% of Americans age 40 and older reported that they don’t expect to have to rely on Medicaid to help pay for their ongoing living assistance expenses as they age.

The actual costs for long-term care are staggering.  The Genworth Survey reported that, nationwide, the average bill for a nursing home is approximately $80,300 and for home health care, approximately $44,616, with a variety of options among and in between these levels of care.

Planning for Care

Most Americans are woefully unprepared.  Only one-third of those surveyed were “very or extremely confident” in their ability to pay for long-term care.  While many individuals reported being concerned over leaving family with debt or becoming a burden on loved ones, many decline to actually do anything about it.  In fact, just over 30% of those over age 65 reported being concerned with such planning, while two-thirds of those over 40 reported that they had not undertaken any planning at all.

The survey points to the conclusion that most of us are reluctant to face the possible loss of independence related to aging.  Apparently, this plays a role in the unwillingness to plan for the possibility of needing assistance later in life.  

As an For example, there was an interesting difference in the number of people surveyed who had planned, or talked to loved ones about, their funeral arrangements (65%), in those who had discussed care preferences with family (42%) and in those who had saved money for long-term care (33%).  Apparently it’s easier for us to talk to loved ones about our deaths than the potential future need for long-term care. 

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4 Things to Do When a Loved One Enters a Nursing Home

Raley L. Wiggins

Sending a loved one to a nursing home for care is never an easy decision.  Families often feel guilty because they cannot provide the level of care that their loved one needs at home.  During such a difficult time of transition, financial or planning issues may be the last thing on your mind.

But the fact is that nursing home care is expensive—somewhere in the range of $6,000 per month—and financial concerns must be addressed.  I hope to give you some idea of what to do if you are faced with this scenario.

1. See an Elder Law Attorney

It is not uncommon for a nursing home stay to devastate a family’s finances.  Neither your private health insurance plan nor Medicare will cover the cost of a long-term nursing home stay, so many patients must pay out of pocket until they run out of money, then apply for Medicaid benefits.

The Medicaid qualification rules are complex.  This is one time in your life where a good attorney can save your family a great deal of money.  Look for an attorney who practices Elder Law.  Many of the Elder Law Attorneys in Alabama are members of the Elder Law Section of the Alabama State Bar, or the National Academy of Elder Law Attorneys (NAELA).

2. Update the Estate Plan

Mr. and Mrs. Smith are in their 80’s and have been married for 50 years.  Mr. Smith enters a nursing home, while Mrs. Smith is healthy enough to continue living in their home.  When Mr. Smith enters the nursing home, Mrs. Smith should update her will to disinherit Mr. Smith to the greatest extent allowed by law.

Sound harsh?  Perhaps.  But consider this.  Mr. Smith must spend down his half of their assets below $2,000 before he can qualify for Medicaid to cover his stay.  Mrs. Smith can protect up to half of their assets for herself.  But, if Mrs. Smith dies first, and her will leaves everything to Mr. Smith, the result is that Mr. Smith loses his Medicaid eligibility, and will have to spend down the other half of their marital assets before he could qualify again.

If Mrs. Smith had updated her will, she could have left Mr. Smith only the minimal amount required by law, and passed the rest on the their children.  And, the minimal amount left to Mr. Smith could have been protected in a supplemental needs trust, to be used for paying for things to improve his quality of life.  Even better, their children could have inherited what was left in the trust after his death.  Because they did not plan, Mr. Smith died penniless, and their children inherited nothing.

3. Make Funeral Arrangements

Just because someone enters a nursing home doesn’t mean you’re just waiting on them to die.  But this is the time to consider making funeral arrangements.

Medicaid rules allow a nursing home resident to purchase up to $5,000 in prepaid funeral services (or deposit $5,000 into a designated burial fund) without penalty.  The choice is a no-brainer.  An applicant has the option of spending $5,000 on the cost of their care, or pre-paying for an expense that all of us will eventually have.

In addition to the $5,000 in prepaid services, the applicant may actually spend additional funds for other items or merchandise that are part of those prepaid services as well.  For example they may purchase a burial plot, headstone, casket, and a pay for the opening and closing of the grave.  While funeral shopping is probably not anyone’s idea of a fun way to spend a Sunday afternoon, it is absolutely something that should be done while there is money left to do it.

4. Do Your Homework

There is great deal of misinformation out there about nursing homes and Medicaid.  You should be very careful about taking advice from your friend at the coffee shop or Sunday School.  Every case is different, and just because a planning strategy may have worked for someone else, doesn’t mean it will work in your case. 

Do your homework, and get some good legal advice.  The stakes are high, and it’s important to get it right. 

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Special Planning for Special Needs

By Raley L. Wiggins

Attorney at Law | Red Oak Legal, PC

Since the 1960’s, the federal government has implemented a number of programs that help provide basic assistance to people in need.  Programs like SSI, SSDI and Medicaid provide a safety net for many in our society.

For example, Medicaid pays for a great deal of the nursing home care in this country.  SSI provides a minimum level of income for many people with special needs, or who are suffering from some condition which makes it difficult or impossible to support themselves financially. 

But, these programs by design are intended to provide minimal, last-resort benefits for basic necessities like food, shelter, and medical care.

These benefits can be very valuable.  Without Medicaid, nursing home residents would have to come up with about $6,000 per month to pay for their care—most people cannot afford this.  Likewise, for someone with a physical or mental disability, SSI provides some minimal financial support, which over a lifetime really adds up.

What should you do if a Medicaid or SSI beneficiary is set to receive a financial windfall, such as an inheritance, or damages awarded in a lawsuit?  Because many of these programs are “means tested” (meaning eligibility is based upon your income and assets), such a windfall may actually cause the recipient serious problems.

Should you even leave an inheritance to a special needs person, or to a Medicaid or SSI beneficiary?  The answer is yes—but only if you do it right. 

For example, Mr. Smith is in a nursing home, while Mrs. Smith is living at home.  After spending down his half of their money, Mr. Smith is nearly broke and qualifies for Medicaid, which covers the monthly cost of his nursing  home care.  So long as she is living at home, Mrs. Smith can shield about half of their assets and some of their income to support herself.

After Mrs. Smith dies, however, her half of their assets are now available for the cost of Mr. Smith’s care.  The result, without getting too technical, is that Mr. Smith is disqualified from receiving Medicaid benefits, and must now spend down Mrs. Smith’s half of their money on his healthcare before re-applying for Medicaid.

This result could have been prevented with proper planning.

When Mr. Smith went into the nursing home, Mrs. Smith should have updated her estate plan to leave Mr. Smith the minimum spousal share required by law, and left the remainder to their children.  In addition, the share that Mr. Smith received should have been left in what is called a “Special Needs Trust” or “Supplemental Needs Trust” (or “SNT” for short).

This would set aside Mr. Smith’s inheritance in a special fund, the SNT.  Placing his inheritance in the SNT means that it is protected from being spent on his medical care, but does not disqualify him from receiving Medicaid. 

The SNT funds may be tapped to provide Mr. Smith with items or services to improve his quality of life, and to pay for things that Medicaid does not cover.  For example, he could purchase a television or comfortable chair for his room, pay for new dentures or glasses, purchase clothing, pay for his telephone service, etc.  These are items he has no money to pay for, and which Medicaid does not cover. 

The best part, however, is that because Mrs. Smith updated her will to leave Mr. Smith’s assets in an SNT, any money left at his death can pass to their heirs.  This could not have been accomplished if she had not updated her will.

Consider a younger person, someone with a condition or injury that will require lifelong care.  A financial windfall will similarly cause this person to lose eligibility for means-tested government benefits like Medicaid and SSI.  Over the course of a lifetime, these benefits really add up.

Rather than leaving them an inheritance outright, you should establish an SNT instead to help support your loved one, and to improve their quality of life.  You do not need a large amount of money to do so, either.  There are cost effective solutions, such as pooled trusts, which can be used to preserve even a small amount of money while maintaining eligibility.

Anytime you are dealing with massive bureaucracies like the Social Security Administration or Medicaid, there is a great deal of red tape to cut through.  Always consult with an attorney experienced in special needs planning to ensure that your beneficiary receives the maximum benefit of their inheritance as well as protection of government benefits.  

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3 Common Estate Planning Mistakes

By Raley L. Wiggins

Attorney at Law | Red Oak Legal, PC

In our practice, we commonly see the same mistakes being time and again.  Sometimes we see the client early enough to correct the mistake before any harm is done, but not always.  Read on to learn about three of the most common mistakes, and how to avoid them.  

Mistake One – Not Planning for Disability

People are living longer than ever before.  If you need proof, just look around at the number of nursing homes, assisted living facilities, home health agencies, and similar organizations that care for the ever-growing senior population.  The longer we live, the more likely it is that we will deal with a period of disability late in life during which we will need others to help care for us.

The starting point in disability planning is to be sure that you have, at a minimum, a durable power of attorney and an advance directive in place.  Note that not all of these documents are created equal.  For example, most advance directives focus on end-of-life scenarios in the event that we are in a coma, or require machines to keep us alive.  They often fail to adequately address a more common scenario—one in which we require nursing home or other long-term care for an extended period of time.

While the advance directive deals with health care issues, a durable power of attorney grants a person of your choosing (your agent) the authority to handle your business and financial affairs.  Importantly, however, the law is clear that your agent only has the powers which are granted to her in the power of attorney.  The problem is that just reading the terms of the POA won’t necessarily give you the complete picture of what powers your agent does or doesn’t have. 

Under the new Alabama Uniform Power of Attorney Act  (effective January 1, 2012), granting your agent the power to do “everything” you could do yourself, doesn’t actually mean that the agent can handle “everything” they may need to address.  Instead, you have to specifically state that your agent has the power to handle certain kinds of transactions.  That’s why it is important to include expanded powers in your power of attorney, particularly for clients over age 65. 

Mistake TWO – Not Knowing How You Own Your Assets

I regularly teach an educational workshop on estate planning to members of the public, and one of the topics that tends to get people’s attention is the discussion of how you own your assets.  You see, the way your assets are held or titled can have a significant effect upon whether your estate plan “works” the way that you hope it does.

For example, many kinds of jointly owned property will automatically become the sole property of the surviving joint owner upon the death of the other owner, regardless of what the deceased person’s will says about who gets the property.  Similarly, beneficiary designations on life insurance policies, retirement accounts, and other accounts will determine who actually gets the money in those accounts after the owner’s death.  For an average middle class family, the bulk of their estate’s value will consist of three types of assets—the home, retirement accounts, and life insurance proceeds. 

Consider John Doe, whose will leaves his entire estate to his favorite niece, Sally.  Assume John jointly owns a house with his wife, Jane.  He has a 401(k) that names Jane as the death beneficiary, and a life insurance policy that names his son, Billy as the beneficiary.  At John’s death, his wife Jane will own the house and get the money in the 401(k), while Billy gets the life insurance money.  Even though the will leaves “everything” to Sally, she won’t actually inherit anything at all. 

Mistake THREE – Leaving Assets Outright to the Spouse

This mistake is not true in all cases, but consider the increasingly common second marriage.  When each spouse has their own children, this can be a source of hurt feelings when one spouse dies before the other.  The children of the deceased spouse often resent their step-parent for spending “their” inheritance.

The better choice is to leave those assets in trust.  For example, John and Jane get married.  They are both in their 50’s, and each have their own children from prior marriages.  John dies first.  His will leaves the bulk of his estate to Jane, in trust, to make sure her basic needs are provided for.  The terms of the trust, however, prevent Jane from leaving John’s money to her new spouse (if she remarries) or to her own children.  Instead, whatever is left will pass to John’s children after her death.

In conclusion, I’ll leave you with a question:  Do any of these examples sound familiar to you?

 

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Ask An Elder Law Attorney: Can The Nursing Home Take Your Parents' House?

By: Raley L. Wiggins

If you have parents who are 70 or older, listen up.  This article is for you.

Most of us have some experience with nursing homes, one way or another.  Advances in medical science means that Americans are living longer than ever before.  Unfortunately, it has become increasingly common for people to experience some period of disability late in life which requires long-term care.  And the people most often tasked with coordinating a patient’s care are his or her adult children. 

Nursing home care, unsurprisingly, is expensive.  In Alabama, it costs about $5,500 per month (or $183 per day). Most people can’t afford that kind of expense for long.  When patients begin to run out of money, they have to look for help from other sources. 

This is the point in which a great deal of “beauty shop/coffee shop” advice begins to float around.  Everyone has an opinion on what to do next, but most of what you hear on the street is just plain wrong.

One of the most common misconceptions is that the nursing home will “take your house.”  This is just not true.  But that doesn’t mean that you should not do anything.  To the contrary, the threat of losing a great deal of money to the cost of long-term care is very real.  According to the U.S. Department of Health and Human Services, at least 70% of Americans over 65 will require some long-term care services at some point.  Over 40% of Americans over 65 will need long-term care in a nursing home, and the average length of stay is 2.8 years.

Medically speaking, nursing homes provide care to patients who need assistance with their “Activities of Daily Living” (ADL’s) which include things like dressing, bathing, grooming, toileting and walking.  The AARP reports that people over 65 have a 68% probability of either requiring assistance with two or more ADL’s, or of suffering from cognitive decline like dementia.

Entering a nursing home is never anyone’s first choice.  Many families try everything they can to keep a loved one in their home for as long as possible.  According to a study conducted by Genworth Financial, 6 out of 10 potential caregivers responded that they were unprepared to handle the more difficult caregiving tasks, such as bathing, dressing and toileting. 

When a loved one does enter a nursing home, someone is going to have to pay for the cost of their care.  At first, Medicare will pay for up to 20 days of nursing home care, but only for rehabilitation purposes.  After that, Medicare will pay only a small portion of the cost of care for another 100 days, but only if you (or your Medicare supplement policy, depending upon which one you have) pay a hefty daily co-pay. 

After that, you’re on your own.

If you have a long-term care policy, it may cover some or all of the cost of care, depending on the policy.  If you don’t then you have to pay the monthly bill out of your own pocket.

Once you run out of money, the last resort is to turn to Medicaid, which is a combined state and federal program which provides medical care for the very poor.  While many nursing home patients don’t start out as “very poor,” most middle class people will run out of money sooner than later, and will have apply for Medicaid.

This doesn’t mean that the nursing home will take your house to pay their bill.  The source of this misconception is the fact that you cannot have more than a limited amount of assets ($2,000) in order to qualify for Medicaid.  Importantly, however, some assets are “exempt” and do not count against that $2,000 limit.

For example, a patient’s primary residence will not be counted as long as they have an “intent to return home” in the future, or if they have a spouse or a blind or disabled child living in the home.  If none of those exceptions apply, then the house may eventually be counted, and Medicaid (not the nursing home) may require a lien against the property as a condition of eligibility.  But even this lien will not be foreclosed during the patient’s lifetime.  Instead, Medicaid has the right to recover money from the sale of the property after the patient’s death, and only up to the amount that Medicaid expended on the patient’s care. 

Does this mean that you should “do nothing” to protect the house or other assets?  Of course not.  Consider Medicaid Planning as part of your overall estate plan.  A qualified elder law attorney can help you (or your parents) create a plan to protect the maximum amount of your assets from the cost of long-term care.

 

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Diagnosed with Alzheimer’s or Dementia: Now What?

At the most basic level, our lives are the sum of our experiences, our relationships, and our memories. For someone suffering with Alzheimer’s or dementia, the building blocks of one’s very identity may slowly crumble away as the disease progresses.

Alzheimer’s is the most common form of dementia, accounting for between 50 and 80 percent of all cases. Early stage Alzheimer’s or dementia is sometimes mistaken for “forgetfulness,” but these memory problems progressively become worse over the course of four to twenty years.

For someone facing dementia, it’s important to make sure their legal affairs are in order sooner rather than later—time is of the essence. Just because an individual has been diagnosed does not necessarily mean that they cannot make any plans with regard to their care or their estate. Particularly with early or moderate stage patients, they may still have sufficient legal capacity to execute certain legal documents, like a will or a power of attorney.

At some point, however, a dementia patient may lose the ability to sign any legal documents. When that happens, the family can be in a real pickle—their loved one doesn’t have the capacity to handle their own affairs, but no one else has the legal authority over their affairs either. Contrary to what you may have heard, an individual’s spouse or other next of kin doesn’t automatically have the right to make legal or health care decisions when their loved one becomes incapacitated.

In those cases, the family has to file a petition with the probate court to have a guardian and/or conservator appointed. Compared to planning ahead, this is a very time-consuming and expensive process.

Unfortunately, many families find themselves in this position at least in part because they didn’t know how to broach the subject with their loved one. Because of the progressive nature of Alzheimer’s and dementia, this is one case in which ignoring the problem won’t make it go away.

It’s not uncommon for someone facing a diagnosis of dementia to feel as though they are losing control. This can make them reluctant to discuss their financial or legal affairs with their family. If you’re facing this dilemma, don’t be afraid of a difficult conversation. Focus on the fact that by planning now, someone diagnosed with dementia can maintain control over their future by expressing their wishes today.

 

This article was published in Prime Lifestyle Magazine - September/October 2013 Edition

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How do People Really Pay for Long-Term Care?

By Raley L. Wiggins

Many people believe that Medicare pays for the cost of long-term care.  In fact, Medicare only pays for up to 20 days of nursing home care, and only then for rehabilitative purposes.  After that, Medicare may cover part of the cost of up to an additional 100 days, during which the patient has to pay a $152 per day copay—hardly a bargain.  A Medicare supplement policy may cover the copay, depending on the plan. 

After that, there are generally two sources of payment: a long-term care (LTC) insurance policy, or your own pocket.  LTC insurance is great if you actually have it, but the fact is that most don’t.  According to the AARP, only about 12% of all of the LTC provided in the U.S is paid for by LTC insurance. 

What happens when you run out money?  You must look to Medicaid for assistance.  Medicaid is designed to provide medical coverage for the very poor, that is, people who have less than $2,000 in assets, and limited monthly income.   Importantly, you can’t “give away” assets in order to get below the $2,000 threshold. 

A common misconception is that elderly people should transfer the house or other assets to their kids in order to “protect” it from Medicaid or the nursing home.  In fact, this is rarely a good idea, and can often have the opposite result.

You see, when an individual applies for Medicaid long-term care benefits, Medicaid will review 60 months (5 years) of their financial records to determine whether the applicant has made any “uncompensated transfers,” or gifts of property.  If any are discovered, then a penalty is assessed. 

For example, if Mother deeded her house, worth $99,000 to her Daughter in 2012, and then required nursing home care in 2014, Medicaid would review her financial records and see the transfer.  The gift of the house would result in the assessment of an 18-month penalty.

This 18-month penalty, during which Mother would not be eligible for Medicaid benefits, would only begin to run after Mother has spent virtually all of her money. The worst part?  If she had done nothing at all, Mother would likely have become Medicaid eligible.

Before giving property to the kids, talk with an elder law attorney to be sure you understand the consequences.  The stakes are too high not to.

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My mother is 85 years old and living with us. . .

Question from Becky, Millbrook, AL:

My mother is 85 years old and has been living with us for the past year. For now, we’re managing to take care of her, but we’re concerned she may need to go to a nursing home in the future. If that happens, how will she pay for it? Will insurance cover it, or will we have to pay for it?

 

Response from Elder Law Attorney Raley L. Wiggins, Montgomery, AL:

Becky, many families feel a sense of duty to care for their parents during old age, often at great personal sacrifice to themselves, and this care is valuable. The Congressional Budget Office estimated in 2011 that the economic value of services provided to elderly Americans by caregivers like you was about $234 Billion, which was more than the total amount spent on paid care giving from all other sources, including Medicare and Medicaid.

Long-term care is very expensive. The Alabama Medicaid Agency estimates the average nursing home cost of care in Alabama to be $5,500 per month. At that rate, most of us could not afford to pay out-of-pocket for very long.

To answer your question, I think you need to know about how people pay long-term care.

Many people believe that Medicare pays for the cost of long-term care. In fact, Medicare only pays for up to 20 days of nursing home care, and only then for rehabilitative purposes. After that, Medicare may cover part of the cost of up to an additional 100 days, but the patient will be responsible for a copay of $152 per day during that time. A Medicare supplement policy may cover this copay, but it depends upon the plan. The best-case scenario is that Medicare and a Medicare supplement policy will cover a maximum of 120 days of rehabilitative nursing home care.

Once Medicare runs out, your mother could pay for the cost of her care out of her own resources, if she is able. If she has long-term care insurance, it may pay for some or all of the cost of her care as well, depending upon the policy. But according to the AARP, long-term care insurance only pays for about 12% of all long-term care costs in this country.

This means that most people need to consider what will happen when and if they run out of money. When that happens, they will need to look to Medicaid to help pay for the cost of care. In Alabama, Medicaid pays for the majority of all nursing home care.

Medicaid is combined state and federal program that provides medical coverage for the very poor. This means that you cannot have more than a limited amount of income or resources in order to qualify. But here is the catch—patients cannot “give away” their assets in order to qualify for Medicaid.

A common misconception is that elderly people should convey the house or other property to their kids in order to “protect” it from Medicaid or the nursing home. In fact, this is rarely a good idea, and can often have the opposite result.

You see, when an individual applies for Medicaid long-term care benefits, Medicaid will review 60 months (5 years) of their financial records to determine whether the applicant has made any “uncompensated transfers,” or gifts of property. If any are discovered, then a penalty is assessed by taking the uncompensated value of the gift and dividing it by the average monthly cost of care (currently $5,500 per month).

For example, if Mother deeded her house, worth $99,000 to her Daughter in 2012, and then required nursing home care in 2014, Medicaid would review her financial records and see the transfer. The gift of the $99,000 house, divided by the $5,500 monthly cost of care, would result in the assessment of an 18-month penalty.

This 18-month penalty, during which Mother would not be eligible for Medicaid benefits, would only begin to run after Mother has spent virtually all of her money. The worst part? If she had done nothing at all, Mother would likely have become Medicaid eligible. This is because her home would have been considered “exempt” property (at least temporarily) that Medicaid would not count against her for purposes of determining eligibility.

There is a great deal of misinformation floating around about Medicaid, nursing homes and long-term care costs. If your mother does ever need nursing home care, carefully read the admissions documents to make sure you understand what you’re signing. A nursing home cannot require a family member to be personally liable for the cost of their parent’s care as a condition of admission or continued stay in a facility. Consider consulting with an elder law attorney in your area who can help you protect yourself, and preserve the maximum amount of your loved one’s assets.

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Questions answered by Estate Planning and Elder Law Attorney, Raley L. Wiggins - Red Oak Legal, PC, Mongomery, AL

"Ask an Elder Law Attorney" is published monthly in Boom! Magazine (Montgomery)

Send your questions for Ask an Elder Law Attorney to news@redoaklegalpc.com or visit our website to submit your question online. Certain questions may be selected to be in the next "Ask an Elder Law Attorney" column.

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What to Do When Mom & Dad Need Help

By: Raley L. Wiggins

As an attorney who practices elder law, most people think that everyone I work with is, well “old.” And while I do work with the elderly, the fact is that most of the time it’s their adult children who call me when they don’t know what to do.

A typical first meeting may involve some version of the following. Daughter comes to see me, and tells me that her elderly mother (“Mom”) has been living alone ever since her father died. Mom has been very independent until recently, when Daughter began to notice some changes. At first, it seemed like ordinary old-age forgetfulness, but lately, Mom is struggling with everyday chores like paying bills, balancing her checkbook, and keeping up the house. Daughter wants to help Mom, but she’s not sure exactly what to do. As far as she knows, Mom hasn’t executed a power of attorney, last will and testament, or other planning documents.

In this case, Daughter has come to us in the nick of time. Even if Mom is starting to experience some cognitive decline, she may still be mentally competent to execute some simple but effective planning documents.

Most people I meet have heard of a power of attorney (“POA”) but don’t understand exactly how they function. They tell me that they need to get power of attorney “over” someone—but that’s not how it works. Instead, a POA must be voluntarily given by the person executing it (called the Principal) to the person receiving it, called the Agent.

In the example above, Mom could give Daughter her POA so long as she is mentally competent to understand what she is doing. Importantly, however, all POA’s are not created equal. One POA may grant an agent very broad authority to nearly anything the principal herself could do, while another may limit the agent’s authority to certain acts. It’s important to talk with your attorney to understand exactly what powers are being granted. If the POA is durable, Daughter can continue to manage Mom’s financial affairs, even if Mom later becomes legally incompetent.

We also commonly get questions about transferring assets. Clients are often concerned about getting a parent’s home or other assets transferred from the parents to the adult children in order to protect it. This is rarely a good idea.

It may seem obvious, but when a parent transfers assets to their children the parent no longer owns the asset. So what’s the risk, you ask? Consider this: What happens if one of the children file for bankruptcy? Files for divorce? What if one of them is sued?

You see, even if the entire family is on board, and even if the children are honest, caring people with good intentions, that may not be enough. Because the children are now the owners of their parent’s property, they have exposed the property to the risk that it could be used satisfy a child's creditors in bankruptcy, or that it could be divided in a child's divorce, or any number of risks. Does transferring assets to the children protect the elderly parent in these situations? The answer is no.

One more consideration: what if an elderly parent needs long-term care? If they have given away any assets at any time within five years before going into a nursing home, they could be harshly penalized and disqualified from receiving benefits that could otherwise be used to pay for the cost of that care.

You may already know that one month of nursing home care in Alabama currently costs about $5,500 per month. Most people quickly run out of money and wind up looking to Medicaid to pay for their care. Medicaid is a means-tested program, meaning that if you have more than $2,000, you won’t qualify. In addition, you can’t give away your assets in order to qualify.

For example, if Mom deeded her home to Daughter two years ago and needs to go to a nursing home today, Medicaid will review the last five years of her finances and see that transfer. Because you cannot give away assets and qualify for benefits, Medicaid will impose a penalty against Mom and disqualify her for a number of months based upon the value of the home. Ironically, had Mom kept the home, Medicaid rules would have permitted her to keep it as exempt property that does not count against her $2,000 asset limit, at least for a while.

Many adult children find it difficult to start a conversation about money with their parents, and vice versa. But remember this: you (and your siblings) will have to handle your parents’ affairs if the need arises. Don’t be afraid to step outside your comfort zone and have a difficult conversation today—you can thank yourself later.

This article was published in Boom! Magazine, June 2014 edition.

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Cost of Long-Term Care Insurance Increasing

By Raley L. Wiggins

I’m a believer in Long-Term Care Insurance.  Regular readers of this blog know that the cost of Long-Term Care (“LTC”) in a nursing home setting in Alabama currently exceeds $5,500 per month, and LTC insurance can help protect you against the ever-increasing cost of care.

But the cost of care isn’t the only thing going up, up and up—so is the cost of LTC insurance.

Part of the work we do at Red Oak Legal is to counsel families with loved ones entering a LTC facility.  Often the biggest question is how the family will pay for the cost of care.  Most do not have LTC insurance. 

According to a report by the Philadelphia Inquirer, fewer than 8% of Americans nationwide have any LTC insurance, and those seeking coverage now will pay more than ever before.  According to the article, LTC policies issued during the 90’s and early 2000’s “were plagued with numerous problems” that left insurers holding the bag for more claims than they anticipated.  Now they are adjusting rates to try and recoup the cost of their earlier mistakes.

Cost is a big hurdle for many people considering LTC insurance.  They feel as though they need a policy that will cover the entire cost of their care, at a rate of $200 per day or more.  In my experience, however, a little bit of LTC insurance is better than none at all.

Consider a policy that pays a benefit of only $100 per day.  If the patient’s cost of care is $200 per day, they will spend about $6,000 per month ($72,000 per year) on LTC.  That $100 per day policy reduces the out-of-pocket expenses to $3,000 per month ($36,000) per year.  Still a lot of money, but only half as much.

If the patient has monthly Social Security income of, say $1,000, that money may be applied towards the cost of care as well.  Now, the patient is still drawing down savings at the rate of $2,000 per month.  With an average nursing home stay of perhaps 2 years, the patient has lost a total of only $24,000 of their savings to the cost of care, compared to of a total cost of $144,000 over that period of time. 

Just as with any insurance, the risk of purchasing a LTC policy is that you will spend the money on premiums but never need to use the product.  If you aren’t comfortable with the cost of a full coverage policy, consider a cheaper option that will help reduce your overall exposure without breaking the bank in the mean time. 

In addition, I can’t finish this post without mentioning that long-term care insurance is only part of the equation when it comes to protecting your assets from the cost of long-term care.  A well-drafted and up-to-date estate plan should always be part of your overall asset protection strategy.  

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Helping Families Deal With the Financial and Emotional Costs of Dementia

As many of you know, May was National Elder Law Month. The National Association of Elder Law Attorneys (NAELA) has declared this month the time for Elder Law attorneys across the nation to take time out of their busy practices to help educate the public about Elder Law and how an Elder Law attorney can help seniors and their families by offering solutions to the unique issues that come with aging.

This issue of The ElderCounselor™ will discuss a debilitating condition that many Americans eventually face as they age: dementia. First, we will describe what dementia is and what it isn’t. Then we will turn our focus to its costs to the individual, the family and our nation. As Elder Law attorneys we are specially situated to help find solutions to many of the problems this condition brings with it. While we can’t stop dementia, we can help protect those in its clutches while the medical world continues to seek prevention, treatment and reversal of the condition.

 

Dementia Defined

The Alzheimer’s Association defines dementia as, “a general term for a decline in mental ability severe enough to interfere with daily life. Memory loss is an example. Alzheimer's is the most common type of dementia.”

Dementia is not actually a specified disease. It describes, instead, a general decline in memory or other thinking skills and is identified through a variety of symptoms. Alzheimer’s disease accounts for 60 to 80 percent of dementia cases. In order to be characterized as dementia, at least two of the following mental functions must be significantly impaired: visual perception; reasoning and judgment; memory; communication and language; or ability to focus and pay attention. Dementia is not a normal part of aging as the terms “senility" or "senile dementia” infer. If a loved one is having trouble with any two or more of these mental functions, it’s a good idea to get it checked by a doctor. Dementia is progressive and typically takes over the mental functions over time. In this way, it provides the individual and the family with time to plan for its disastrous affects.

Cost to the Individual

The cost to the individual with dementia is difficult to quantify. Because dementia is a progressive condition and one where aging is the greatest risk factor, it is logical that at the beginning and younger stages of dementia, the cost to the individual is minimal. As dementia progresses, so does the need for assistance with daily activities. This assistance often comes in the form of meal preparation, help with grooming and hygiene, transportation assistance, as well as help with many other daily activities. Dementia patients can become so mentally challenged that they may place themselves in dangerous situations, such as roaming neighborhoods and getting lost. While the individual affected by dementia may need only a few hours of help per week at the beginning of symptoms showing, soon they may need around the clock supervision, not only for assistance with daily activities, but to protect them from themselves. The individual’s costs will include medical expenses as well as paying a caretaker.

Caretaking for one with dementia varies depending on the quantity of care required. An in-home caretaker may charge up to $21 per hour or higher. Adult day care can run as high as $18,200 per year or more. When an individual can no longer live alone but is not quite ready for a nursing home, Assisted Living facilities are available but may cost as much as $42,600 per year or more. When around the clock care is needed, a nursing home can cost an individual up to $90,520 per year, or higher. To view costs in other states and national average costs of long term care, see the MetLife Survey of Long Term Care Costs.

Cost to the Family

Where the individual with dementia is fortunate enough to have family nearby, the family will often step up to assist the ill loved one with their daily activities. Again, the process can be gradual and before the helpful family member realizes it, they may find themselves missing work and, finally, quitting their job altogether in order to give proper care to the dementia patient. Obviously, the cost to the family includes the loss of income from this family member’s job.

The less recognizable cost to the family, however, is the emotional strain that is placed on the family member caretaker. In order to save the family money, many family members will work nearly twenty-four hours, seven days per week. The ramifications are physical, mental and emotional health problems to the caretaker. The medical costs and possible future psychological costs to the caretaker, then, must be considered.

It is important that family members take a step back from the situation and assess this cost. Providing a caretaker with time off every day, week and year is a must to ensure the caretaker’s health. The caretaker must have appropriate support in order to keep caring for the loved one.

Cost to the Nation

As a nation we have begun to recognize the devastation that dementia has caused and will continue to cause. Organizations such as the Alzheimer’s Association have been effective in lobbying for monies to be put towards the research of dementia treatment, prevention and reversal. The cost of dementia to our nation has been a great motivator for politicians to fund such research.

A study conducted by RAND Corporation in 2013, estimated the national cost of dementia to be between $159 billion to $215 billion (including an estimate for the monetary value of informal care provided). The majority of the costs associated with dementia are for institutional and home-based long-term care and not medical services.

Medicare and Medicaid pay for some of this cost, which amounts to a taxpayer burden. According to the Alzheimer’s Association March 2013 Fact Sheet, in 2013 it is estimated that Medicare and Medicaid paid approximately $142 billion in caring for those with Alzheimer’s or other type of dementia.

It is clearly in the best interest of the nation’s economy to continue research on prevention, treatment and reversal of dementia.

Conclusion

The costs of dementia can be devastating to the affected individual, their family and the nation. While scientists continue to search for solutions to the debilitating condition, the families affected with it must face its challenges. It is recommended that those families seek emotional support by way of a therapist or support group. In addition, seeking out an Elder Law attorney can benefit the affected individual and family members in several ways. Elder law attorneys can guide families to important resources available for the financial and other challenges they will face. Elder law attorneys can also ensure that the family’s assets are being used in the most efficient manner considering other available resources and the family’s individual goals.

Getting an Elder Law attorney involved in planning for the challenges ahead is one of the MOST important steps a family facing the impact of dementia will take. If you or someone you know is affected by dementia, we can help and we welcome the opportunity to do so.

Call us today at 205.764.1262 to schedule a consultation.

 

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May is National Elder Law Month

By Raley L. Wiggins

When do you need to talk to an attorney who practices Elder Law . . . and what is Elder Law, anyway?

Attorneys who practice in the area of Elder Law spend a lot of time educating the public about what they do.  The short answer is that they assist clients over age 65 with a variety of legal issues. 

During the month of May, local attorneys who are members of the National Academy of Elder Law Attorneys (NAELA) are celebrating National Elder Law Month in order to raise awareness regarding the legal issues facing this segment of the population.

The real value of an Elder Law attorney is their understanding of the convergence of clients’ legal concerns with their social, medical and financial needs.  That means that Elder Law attorneys don’t just draft wills, trusts, and powers of attorney, they also counsel clients about planning for incapacity with the appropriate healthcare decision-making documents.

In addition, Elder Law attorneys typically help clients plan for their possible long-term care needs, including at-home care and assisted living or nursing home care. Locating the appropriate type of care, coordinating public and private resources to finance the cost of that care, and working to ensure the client’s right to quality care are all part of an Elder Law practice.  Elder Law attorneys are familiar with the network of services and providers who assist clients effectively.

Consider consulting an Elder Law Attorney if you or someone you love:

-          Is entering a long-term care facility (nursing home, assisted living, etc.) and needs help understanding how to pay for their care while preserving assets

-          Needs to appoint someone to make financial or healthcare decisions in the event of incapacity

-          Are concerned about a loved one’s continuing ability to manage their own affairs, due to Alzheimer’s, dementia or other condition

-          Needs to create an estate plan, including a will, power of attorney, healthcare proxy, living trust, etc.

-          Needs assistance navigating and coordinating long-term care benefits through Medicaid or the VA

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Planning & Caring for Adult Special Needs Children

During the last century, the life expectancies of ordinary Americans increased tremendously. At the same time, advances in medical science have enabled special needs children to live longer and fuller lives than what was considered possible just a few short years ago. For example, the life expectancy of children born with Down Syndrome has more than doubled from around 25 years in 1983 to over 50 years in 2008, according to the New York Times.

But while parents are living longer than ever, they may not be able to continue providing the same level of care to their special needs child as they develop their own need for long-term care in their later years. For elderly parents and special needs children alike, the cost of care can be astronomical.

Of course, no one can care for your child like you can, but that doesn’t mean you will be able to care for them forever. That’s why you need to have a formal, written action plan in place, which should include information about housing, financial, social, medical, and other issues.

You should also review your estate plan. Many special needs children rely on means-tested government programs like Medicaid and SSI for help. By leaving even a tiny inheritance to your child, you may inadvertently disqualify them from receiving these valuable benefits. Using a planning device called a Special Needs Trust can protect assets to be used to pay for a child’s supplemental needs (i.e., expenses not covered by government benefits) for years to come. And, if you plan far enough ahead, you may get the added benefit of protecting these assets from being used up on the cost of your own care, should you ever enter a nursing home.

Finally, it’s important to ensure that you have the proper documents in place to appoint someone to act legally on behalf of your child. In addition, the law assumes everyone is legally competent until proven otherwise. Therefore, if your child is an adult and no guardian has been formally appointed by the probate court, you might not be their legal guardian.

The planning needs for parents of adult special needs children change over time. If you haven’t reviewed your plan recently, talk with an attorney who practices in the area of special needs planning.

 

This article was published in Prime Lifestyle Magazine - May/June 2013 Edition

 

Red Oak Legal, PC - Estate Planning | Elder Law | Civil Litigation Attorneys

Firm locations in Tuscaloosa, AL and Montgomery, AL

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LTC Insurance Rates Going Up—Again

As elder law attorneys, we often recommend long-term care insurance as a piece of the asset protection puzzle.  But many people hesitate to purchase LTC insurance because of its perceived expense. 

This high-cost perception certainly isn’t improved by the recent announcement (as reported by InvestmentNews) that the two largest sellers of LTC policies are looking to raise premiums on their current policy holders.  John Hancock, for example, is seeking approval from regulators to raise its premiums by an average of 25%, just three years after seeking approval for rate hikes averaging 40%.

Time to sound the alarm?  Maybe not yet. 

While LTC Insurance is certainly not cheap, the benefits it provides are extremely valuable when compared to the cost.  InvestmentNews gives the following example of the current state of things:

“Currently, a 60-year-old couple purchasing a long-term care policy that will provide them with a combined pool of $708,000 at age 85 can expect to pay on average $3,700 in annual premiums, up 11% from two years ago, according to the American Association for Long Term Care Insurance. The range of the coverage cost was as wide as $2,700 to $4,500 per year.”

The cost of nursing home care in Alabama is some of the cheapest in the U.S., at “only” about $65-$75,000 per year. For most middle-class families, that kind of care will quickly exhaust their life savings.  Even so, many have difficulty forking over the premiums to pay for a bells-and-whistles policy that would cover the entire cost of care.

So how can Alabamians protect themselves from the cost of long-term-care without breaking the bank?

In our experience, some LTC insurance (even a little) is much better than none at all.  If and when you require long-term care, having a benefit that pays even a portion of your monthly expenses, when combined with your monthly Social Security benefits and any other retirement income will at least “slow the bleeding.”

For example, John Doe receives $1,000 per month in Social Security income, and $1,200 from his pension plan.  He has a nest-egg of $150,000 in a CD at the bank, and a paid-for home worth $175,000.  In addition, he has a LTC policy which pays a small benefit of $75 per day.

Mr. Doe later enters the Nursing Home, which costs $6,000 per month (or $200 per day).  Mr. Doe’s LTC policy will pay a benefit of $2,250 per month ($75 per day).  When added to his Social Security and retirement income, Mr. Doe has $4,450 per month in income to contribute towards the cost of his care.  Of course, means that his income will still be $1,550 per month short of his $6,000 per month nursing home bill.

Assuming that Mr. Doe has a longer-than-average stay in the Nursing Home of 3 years, he will have to spend $55,800 of his $150,000 nest egg to pay for his care.  But without his LTC benefit of $75 per day, Mr. Doe would have spent nearly all of his nest egg, a total of $136,800 to cover the monthly shortfall.

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Stealing from the Elderly

The Montgomery Advertiser recently reported on three significant prosecutions during the last five years involving theft of nursing home residents’ funds by a nursing home employee.  According to the article, “[a]t least three people in Elmore and Montgomery counties have been prosecuted in the past five years for taking between $20,000 and $116,000 from nursing home residents’ financial accounts, part of some 1,500 cases nationwide.”

As regular readers of this blog know, nursing home care is very expensive anywhere in the country.  Here in Alabama, the cost of a single month of care in a skilled nursing facility can range between $5,000 and $7,000 per month.  Couple the huge costs with the fact that most nursing homes are filled primarily with the elderly and feeble, and the opportunity for an unscrupulous employee to take advantage of a patient is an unfortunate reality.

It’s important to remember that nursing homes are professional institutions with government oversight that have every reason to avoid this kind of theft.  But if it can happen in that setting, how hard can it be to take advantage of the elderly living alone in the community?

The reality is that most elderly victims of financial abuse are victimized by friends or family members. Often, the victim is talked into granting the individual signatory authority on a bank account, or worse—into granting the individual power of attorney. These crimes often go undiscovered until the money has already been squandered, or even until after the victim has passed away.

Fortunately, Alabama passed the Protecting Alabama’s Elders Act earlier this year, which makes financial abuse of the elderly (including improper use of a power of attorney) a crime.  If you suspect something illegal, a good start would be to check out the many resources available at the Alabama Department of Senior Services’ website, or talk with a local elder law attorney. 

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Study Gives Alabama Nursing Homes Poor Marks

Study Gives Alabama Nursing Homes Poor Marks

A nursing home advocacy group based in Florida called Families for Better Care has published a report grading each state on the quality of its nursing homes. Every state in the Deep South (except for Florida and South Carolina) received a grade of ‘D’ or ‘F’ in the report. 

Alabama, like Mississippi and Georgia, was graded a ‘D.’

Of course, it’s important to remember that this is a comparative study.  Most of the states in our region are relatively poor. They also tend to have fiscally conservative state governments who are reluctant to expand any entitlement programs (like Medicaid) that would further stretch their already thin budgets.

If you have a loved one in a nursing home in Alabama, you shouldn’t jump to the conclusion that they are receiving a sub-standard level of care based on this report.

To protect your loved one, be sure to investigate the available facilities, research your options and ask questions.  Even more importantly, visit your loved one often to see for yourself that they are being properly cared for.  If you are concerned that your loved one’s rights have been violated, contact your local Area Agency on Aging or an attorney who practices Elder Law.

 

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The Hidden Cost of “Observation” Status

After discharge, Winkworth's doctors said she needed to go to a nursing home. But since the hospital considered her an observation patient, not an inpatient, the family had to pick up the bill. And they're not rich. 

 

The National Public Radio website today published an article discussing a topic that is familiar to elder law attorneys: “For Hospital Patients, Observation Status Can Prove Costly.”

The article describes the fairly typical case of 74-year-old Rosalie Winkworth, who spent four days in the hospital after a fall.  During her time there, the hospital classified her as being on “observation status.”  After four days, however, she was discharged to a nursing home for further recovery.

Generally speaking, Medicare does not cover the cost of a long-term stay in a nursing home.  However, they will pick up the tab for a rehabilitative stint in a skilled nursing facility for up to 20 days, under certain circumstances. 

But here’s the problem: Medicare will not pay for the nursing home stay if the patient was discharged from a hospital on “observation” status.  This means that the family is left to shoulder the entire cost.

As the NPR article points out, hospitals are motivated to place patients on observation status because Medicare auditors cannot force the hospital to repay money it received from the program for observation patients.  On the other hand, if the auditors determine that a patient was improperly classified as inpatient or outpatient, then the hospital may be forced to repay Medicare up to three years after the fact.

Currently, there are lawsuits pending challenging the way observation status is used. But if an elderly family member is placed on observation status, make sure you ask the hospital whether classifying your family member as an in-patient might be more appropriate.  In the event they are discharged to a nursing home, it could mean a huge difference in the cost of care. 

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Should Alabama Spend More to Keep Seniors Out of Nursing Homes?

As it stands, our Medicaid program is picking up the tab for two-thirds of Alabamians in nursing homes, at a cost of $900 million a year. But it provides extremely limited funding for services that can keep people out of nursing homes. Only 15 percent of Medicaid long-term care spending goes to services other than nursing homes. 

 

A letter to the editor submitted to al.com by the state director of AARP Alabama, Jesse Salinas, asks whether Alabama is willing to do more to keep the elderly out of nursing homes by increasing spending on community-based care.  In his letter, A little help can keep our seniors out of nursing homes and save taxpayers money, Mr. Salinas notes that the Alabama Medicaid Agency pays for over two-thirds of nursing home care in our state, but that only a small portion of the total long-term care dollars are spent for services outside of an institutional setting.

It seems clear that some people who wind up in a nursing home who would be able to stay home if they had access to some community-based long-term care services.  (At least in theory, however, nursing home residents should require a level of care which is only available in a skilled nursing environment in order to become qualified for assistance from the Alabama Medicaid Agency).

In addition, it’s important to understand that an individual can only qualify for Medicaid long-term care benefits in Alabama if they have very limited income and assets.  For example, a single person cannot have more than $2,000 in any given month and remain eligible for nursing home benefits. 

While Alabama Medicaid does exempt an individual’s home (under certain circumstances) when calculating the $2,000 limit, it is easy to imagine a scenario in which an elderly patient with limited income and less than $2,000 in assets would have difficulty maintaining their home and a minimally adequate standard of living for someone in that condition.

It remains to be seen what, if any community-based Medicaid options our legislature will come up with. But hopefully any new programs they implement will be designed with an eye towards providing vulnerable nursing home patients with meaningful choices while at the same time maximizing the Alabama Medicaid Agency’s budget. 

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Nursing Home Stay Can Ruin Finances

Median household wealth for those who spend fewer than 30 days in a nursing home is about $108,000. But after 6 months, many nursing home residents are effectively broke, with median assets of barely $5,000. In other words, after 6 months in a nursing facility, half of all residents lose essentially all their wealth.

The message behind an article that Forbes.com published back in 2012 demonstrates just how costly a typical nursing home stay can be. As quoted above, median household wealth—including home equity—is reduced from $108,000 to around $5,000.

Of course, in Alabama, even an individual with only $5,000 left would not qualify for assistance in paying for long-term care from the Alabama Medicaid Agency because in our state, you may only have a total of $2,000 in countable assets to qualify for Medicaid long-term care benefits.  

As noted in the article, Medicare will only pay for a few days of rehabilitative care in a skilled nursing facility (nursing home), after which a patient needs to find a different source of payment. In Alabama, the average monthly cost of nursing home care is over $5,000. Nursing home patients without any long-term care insurance must generally pay these costs out-of-pocket until they have spent-down the bulk of their assets.

If your family is currently applying for Alabama Medicaid nursing home benefits, or if a loved one is entering a nursing home, consider contacting an elder law attorney who can help you determine how to pay for your loved one’s care while preserving assets for the patient’s benefit.   

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Advance Directives: Should be Drafted in Advance

This uncomfortable, ethically questionable, confusing scene over Ms. Bayliss’ end of life did not have to happen the way it did.  If you don’t want to be in that kind of situation, you need to be responsible for deciding what you want and communicating it to those who will have to act on your behalf.

Recently, an elderly woman named Lorraine Bayless collapsed at the Glenwood Gardens nursing home. Because nursing homes are generally full of people in poor health, that fact alone is unremarkable.  But the 911 call that resulted made national news for what sounded unbelievably harsh and cold behavior on behalf of the facility’s staff.

You see, after Lorraine fell into cardiac arrest the facility was unable to administer CPR, despite the pleading of the 911 operator. Why? “Company policy.”

This matter has been taken up by Forbes in two recent articles, by two different authors. The first, by Howard Gleckman, is titled “The CPR Death At Glenwood Gardens: What Really Happened And Five Lessons You Should Learn.” The second Forbes article is penned by Carolyn Rosenblatt and is titled “Nurse Refuses To Give CPR, Senior Dies: Ethical Problem Or Legal Issue?”

Here are four key facts regarding this story. First, Lorraine was having a stroke, and CPR was not likely to help her. Second, the “nursing facility” was actually an independent living facility without skilled nurses (like RN’s). Third, Lorraine herself had not wanted a long drawn out passing; and fourth, Lorraine and her family already had arranged for a Do Not Resuscitate (DNR) order.

Against this backdrop, each of us needs to know two fundamental wishes when it comes to our loved ones:

1)     What does your loved one want and need in a facility? Since the facility in question was not an actual nursing home and the “nurse” was not actually a skilled nurse, the staff was not allowed to perform CPR, both by “company policy” and by law. There are many types of facilities with varying degrees of medical or personal care. Truly, to be in the “wrong” facility may mean not limiting the care your loved one may want.

2)     Likewise, what does your loved one want (or not want) when it comes to end-of-life measures? What decisions has your loved one made regarding emergency care, resuscitation, breathing or other life-sustaining apparatuses? Lorraine purposefully had a DNR, had made her decision, and her family clearly knew her wishes. Nevertheless, there are many additional considerations when it comes to making and communicating your wishes.

Putting your wishes in writing helps to ensure that your family and medical team know what you want, and don’t have to guess at what you would have wanted. The most common form is known by many different names, but is simply a written record of their healthcare directives made in advance.

There are several options available with some variation as to what they are designed to accomplish.  This includes a “living will,” an “advance directive,” a “healthcare proxy,” or a “durable power of attorney for healthcare.”

Regardless of what document you choose, the goal is to empower your senior loved ones to inform their loved ones, doctors and medical or long-term care facilities about their wishes now so those wishes can (and will) be carried out later. And, once executed, copies of the health care directives should be liberally distributed among agents, non-agent family members, doctors and medical facilities. As these end-of-life wishes also are emotional decisions, it is best if everyone concerned is informed rather than surprised.

Of course, waiting until you are classified as a “senior citizen” to undertake this kind of planning is not a good idea either. The time to make your wishes known is now, while you’re in good spirits and of sound mind and body.  As the Bayless family learned, having your wishes carried out can be hard—but without a plan no one will know what those wishes are.

Reference:

Forbes (March 8, 2013) “Nurse Refuses To Give CPR, Senior Dies: Ethical Problem Or Legal Issue?”

Forbes (March 6, 2013) “The CPR Death At Glenwood Gardens: What Really Happened And Five Lessons You Should Learn”

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