Resources for Adult Care-providing Children of Senior

Elder Law encompasses many different fields of law which is important to note because the legal problems that affect the elderly are continuously growing in number. Current laws and regulations are also becoming more complex and therefore more challenging for you the adult child of the senior. Attorneys that specialize in dealing with the elderly must have a broad understanding of the laws that impact a given situation to avoid future problems for the senior and their heirs.

Areas of Elder Law Include:

• Preservation/transfer of assets seeking to avoid spousal impoverishment when a spouse enters a nursing home
• Medicaid
• Medicare claims and appeals
• Social security and disability claims and appeals
• Supplemental and long term health insurance issues.
• Disability planning, including use of durable powers of attorney, living trusts, “living wills,” for financial management and health care decisions, and other means of delegating management and decision-making to another in case of incompetency or incapacity.
• Conservatorships and guardianships
• Estate planning, including planning for the management of one’s estate during life and its disposition on death through the use of trusts, wills and other planning documents
• Probate
• Administration and management of trusts and estates
• Long-term care placements in nursing home and life care communities
• Nursing home issues including questions of patients’ rights and nursing home quality
• Elder abuse and fraud recovery cases
• Housing issues, including discrimination and home equity conversions
• Age discrimination in employment
• Retirement, including public and private retirement benefits, survivor benefits and pension benefits
• Health law
• Mental health law

As with any specialty attorney, most Elder Law attorneys do not specialize in every one of these areas. So when an attorney says he/she practices Elder Law, find out which of these matters he/she handles and has years of expertise doing. Remember to hire the attorney who regularly handles matters in the area of concern in your particular case. He/she should also know enough about the other fields related to your issue to question whether the action being taken might be affected by laws in any of the other areas of law on the list. For example, if you are going to rewrite your estate plan and your spouse is ill, the estate planner needs to know enough about Medi-Cal to know whether it is an issue with regard to your spouse’s inheritance and legal rights after the spouses passing.

Attorneys who are members of NAELA, the National Academy of Elder Law Attorneys, are focused on continual education in the many areas that elder law touches; so you should ask your elder law attorney if they are affiliated with NAELA. Attorneys who primarily work with the elderly bring more to their practice than an expertise in the appropriate area of law. They bring a long standing knowledge of senior’s needs and that allows them and their staff to empathize with some of the challenging physical and mental difficulties that often accompany the aging process. Any high quality elder law attorney will understand the afflictions of the aged and can therefore offer advice that can more easily determine the best course of action for the client. They are more aware of real life problems, health and otherwise, that tend to overtake us as we age. Elder law attorneys are also usually tied into a system of social workers, psychologists, caregivers and other elder care professionals who may be of assistance to you. All of these things will hopefully make you more comfortable when dealing with them and ease your way as you try to resolve your legal problem.

Planning for the unexpected in our elder years had gotten decidedly more complex over recent years. And even when you save and plan, what happens when part of your plan gets cut out right from under you? For example, relying on Medicaid (here in California its Medi-Cal) to support your long-term care living situation. Unfortunately, that is exactly what happened to 6 senior residents of assisted-living centers along the Gulf Coast. As reported by the Peninsula Daily News, by the end of June 2010, two assisted-living facilities will have evicted six of their elderly residents because they are on Medicaid and the facilities’ Medicaid contract is not going to be renewed due to underpayment of the actual cost of care. These are seniors that saved for retirement, invested wisely and had long term care coverage- or so they thought.

Edith Bateman, 93, left, and Lucile Cole, 98, are among the residents evicted from Prairie Springs, a Sequim assisted living facility that will end its Medicaid contract as of June 30. -- Photo by Diane Urbani de la Paz/Peninsula Daily News

According to the facilities’ CEO it costs the facility more to take care of people than what Medicaid pays so they are simply not continuing with their Medicaid contracts. The state Legislature passed a law in 2008 prohibiting the eviction of residents with Medicaid but if a facility has no Medicaid contract they aren’t subject to that state requirement. A convenient loop hole if you’re in the long term care business.

So what are you other options? Let’s look at long term care insurance instead of Medi-Cal. Today, the cost of a nursing home, according to AARP, is about $62K a year nationwide and the average patient stays for 2.4 years- that’s a total cost of around $148,000. Long term care policies are all over the place but for argument’s sake, say you get a standard policy for a 55-year old man that would pay out up to 131,400. That’s almost enough for 2.4 years in a facility. That policy would cost around $16,113 over a 30 year period. Unfortunately, the basic policy doesn’t meet or cover all of your needs and since we are living longer and longer because of medical breakthroughs chances are you will need more extensive coverage.

This means you would need a more expensive policy, somewhere in the $200-300/month range to really cover those expenses. And to even start using your benefits you need to satisfy the policy requirements like needing help with daily living, ie: bathing, dressing or eating. Also premiums rise over time, on average about 5% per year, and the total benefit might still fall short of the continuing rising cost of long term care by the time you need it.

These are the unfortunate circumstances of living today. This is why Life Care Planning is so important- so that you can map out not only your savings and emergency plan but for the unexpected long-term needs of yourself or your older loved ones down the line. Evaluate your need for a long term care insurance policy with the following guidelines in mind.

Who Should Consider a LTC Policy?

• Those we want some flexibility in choosing the type of long-term care they receive.
• People who can afford current and future (inflated) premiums
• People who has significant income and other assets and don’t want to run through them all if long-term care is needed
• Anyone who doesn’t want to rely on family/friends for financial support

The sad truth is people are consistently outliving their savings, or losing large portions of their investment holdings before it can be used for long-term health care expenses. Even seniors who counted on pensions, investments and Social Security can be caught in a situation like the 6 evicted seniors in the Gulf Coast. Planning for the worst is never a bad idea in today’s economy. Even smarter is planning with an attorney who has seen this situation time and again and can guide you on how to avoid it.

There are many challenges for adult children caring for aging parents and grandparents. Among these are the threats of depression which hits more elder persons than you might think. In fact, as many as 70% of institutionalized elderly experience significant depression, and the incidence in community settings is approximately 18% in the over 65 population (as opposed to 8% in the general population). Some estimates of frail elderly living in independent settings have found a 30% or higher incidence. Depression is a medical condition that affects not only quality of life, but also the way in which people take care of themselves. It is a condition that is usually easily resolved with new treatments like therapy, antidepressants or a change in living accommodations, but untreated in the elderly, it can have terrible consequences.

Loss is painful—whether an elder is dealing with a loss of independence, mobility, health, a long-time career, or someone they love. Grieving over these losses is normal, even if the feelings of sadness last for weeks or months. Losing all hope and joy, however, is not normal. It’s depression.

According to the National Institutes of Health, of the 35 million Americans age 65 or older, about 2 million suffer from full-blown depression. Another 5 million suffer from less severe forms of the illness.

Causes of Depression

Many seniors face significant life changes and stressors that put them at risk for depression. Those at the highest risk include older adults with a personal or family history of depression, failing health, substance abuse problems, or inadequate social or emotional support.

Causes and risk factors that contribute include:

• Loneliness and isolation – Living alone; a dwindling social circle due to deaths or relocation; decreased mobility due to illness or loss of driving privileges.
• Reduced sense of purpose – Feelings of purposelessness or loss of identity due to retirement or physical limitations on activities.
• Health problems – Illness and disability; chronic or severe pain; cognitive decline; damage to body image due to surgery or disease.
• Medications – Many prescription medications can trigger or exacerbate depression.
• Fears – Fear of death or dying; anxiety over financial problems or health issues.
• Recent bereavement – The death of friends, family members, and pets; the loss of a spouse or partner.

Signs and Symptoms

• Sadness
• Fatigue
• Abandoning or losing interest in hobbies or other pleasurable pastimes
• Social withdrawal and isolation (reluctance to be with friends, engage in activities, or leave home)
• Weight loss; loss of appetite
• Sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness)
• Loss of self-worth (worries about being a burden, feelings of worthlessness, self-loathing)
• Increased use of alcohol or other drugs
• Fixation on death; suicidal thoughts or attempts

Older adults don’t always fit the typical picture of depression. Many depressed seniors don’t claim to feel sad at all. They may complain, instead, of low motivation, a lack of energy, or physical problems. In fact, physical complaints, such as arthritis pain or headaches that have gotten worse, are often the predominant symptom of depression in the elderly. Older adults with depression are also more likely to show symptoms of anxiety or irritability. They may constantly wring their hands, pace around the room, or fret obsessively about money, their health, or the state of the world.

Older adults who deny feeling sad or depressed may still have major depression. Here are the clues to look for:

Adapted from American Academy of Family Physicians

Other tips for helping a depressed parent or grandparent:

• Invite them out. Depression is less likely when people’s bodies and minds remain active. Suggest activities to do together that your loved one used to enjoy: walks, an art class, a trip to the museum or the movies—anything that provides mental or physical stimulation.

Schedule regular social activities. Group outings, visits from friends and family members, or trips to the local senior or community center can help combat isolation and

Medicare is often a confusing and exhausting system to navigate. Particularly if you are caring for aging parents or in-laws and do not always have the right forms or information. Here are some things you need to know about long term care entitlements and how to make sure you get your family the best possible care while spending the least amount possible.

Remember, older adults do not have to use all available resources, such as savings, before Medi-Cal might help pay for all or some of the costs of a nursing facility! And, anyone seeking long term care benefits under Medi-Cal is NOT required to use up their assets to the $2,000 level… they are required to have no more than $2,000 in Available Assets. Assets may be transferred or re-categorized at any time if the transfer falls within Federal and State rules. There is a 30 month “look back period,” during which an applicant may be denied eligibility because assets have been transferred in violation of Federal or State rules.

• Medi-Cal by law is required to provide every applicant for long term care benefits with a form called the DHS 7077.
• Medicare will pay 100% of care fees up to 20 days in a skilled during facility (rehab) and another 80 days with a deductible of $119 per day.
• At the end of 100 days in rehab or a sub-acute facility, or if re-classified as a ‘convalescent’ during the 100 days, Medicare will cease payment of benefits. However, Medi-Cal may pay for care.
• The program accommodates anyone that is indigent. But it also accommodates older middle-class Americans specifically the aged, blind and the disabled.
• Your basic choice to pay for care include:
  • Private Pay (You write the checks every  month yourself)
  • Long Term Care Insurance Benefits (If you have any)
  • Use your entitlement under the Medi-Cal Long Term Care program

Finding out what your benefits are and how to best apply for utilize them is critical. If you’re taking care of your parents or in-laws and need help don’t wait. Call 562-627-9600 for a free consultation with a licensed elder law attorney. It could make all the difference for you and your loved ones.

Information Directly from the Secretary of Health and Human Services You Need to Know!

The new health care law will start rolling out soon. Here are a few of the important pieces for seniors.

Firstly, there will be more accountability throughout the health care system so that you, your family, and your doctor, not insurance companies, have greater control over your care.

• These improvements will keep Medicare strong and solvent
• Guaranteed Medicare benefits won’t change-whether you get them through Original Medicare or a Medicare Advantage plan. And, you will see new benefits and cost savings
• More affordable prescription drugs
• Next year you get free preventative care services like cancer and mammogram screenings plus a free annual physical
• The new law levels the playing field and gradually eliminates Medicare Advantage overpayments to insurance companies
• New voluntary insurance program called CLASS to help pay for long-term care and support at home
• Individuals on Medicaid will receive improved home- and community-based care options, and spouses of people receiving home- and community-based services through Medicaid will no longer be forced into poverty
• New tools and resources in the Elder Justice Act, which was included in the new law, will help prevent and combat elder abuse and neglect, and improve nursing home quality.
• Insurance companies will be prohibited from denying coverage due to a pre-existing condition for children starting in September, and for adults in 2014.
• Insurance companies will be banned from establishing lifetime limits on your coverage, and use of annual limits will be limited starting in September

What Stays the Same:

• The guaranteed Medicare benefits you currently receive will remain the same. During open enrollment this fall, you will continue to have a choice between Original Medicare and a Medicare Advantage plan. Medicare will continue to cover your health costs the way it always has, and there are no changes in eligibility.
• If you are in a Medicare Advantage plan, you will still receive guaranteed Medicare benefits.
• Your choice of doctor will be preserved- the law increases the number of primary care doctors, nurses and physician assistants to provide better access to care

Read the full brochure online!

Call 1-800-MEDICARE or go on-line at Medicare.gov if you have questions or concerns. Don’t give your personal Medicare information to anyone who isn’t a trusted source.

In preparation for World Elder Abuse Awareness Day (June 15th), we are sharing some program highlights from the Archstone Foundation Elder Abuse & Neglect Initiative that were shared with us via newsletter. Our hope is that these programs, which are setup to be duplicated, will spread throughout Southern California and finally start to tackle some of these elder abuse issues we fight every day. Thank you for reading these and for passing them along.

Senior Center Protection Plan, by the Fair Lending Project for Seniors

Fighting scams at senior centers takes a multidisciplinary team effort that is comprehensive instead of piecemeal.  Our project develops a county-wide awareness campaign about financial exploitation occurring in senior centers and a step-by-step plan that cities can use to protect seniors from harm.  A coalition of senior center directors, the District Attorney’s Office, local legal services agencies, city policy planners, private bar, senior advisory boards, and real estate and life insurance professionals works together to accomplish our goals.

Initial Considerations and First Steps: (MS Word)

www.centeronelderabuse.org/files/ElderAbuseinHomeLendingProtection.doc

Sample Materials:

• Reverse Mortgage Letter (MS Word) www.centeronelderabuse.org/files/Reverse_Mortgage_Letter.doc
• Predatory Home Mortgage Screening Tool (MS Word) www.centeronelderabuse.org/files/Predatory_Home_Mortgage_screeningtool.doc
• Fair Lending Project Brochure (PDF) www.centeronelderabuse.org/files/FairLendingProject_Brochure.pdf

Contact person for more information:

Name: Shawna Reeves

E-mail: sreeves@scccoa.org

Telephone: 408-350-3229

Establishing an Elder Abuse & Neglect Screening Protocol in a Dental Teaching Clinic, by University of California, Los Angeles, School of Dentistry

This UCLA School of Dentistry project focuses on developing a screening tool and reporting protocol for pre-doctoral dental students to use while working in the dental clinic. The screening tool, tailored for use in a dental teaching clinic, is also appropriate for use in private practice. Given that dentists are mandated reporters, there is a strong reason to adopt this screening tool and protocol in dental teaching clinics throughout California.

Initial Considerations and First Steps: (MS Word)

www.centeronelderabuse.org/files/from _Classroom_to _Clinic_UCLA.doc

Sample Materials:

• Handout “Elder Abuse & Neglect Reporting Protocol introduced at the UCLA School of Dentistry Clinic” (PPT) www.centeronelderabuse.org/files/EAN_Reporting_Dentistry_ Handout.ppt
• Screening and Reporting Overview (PDF) www.centeronelderabuse.org/files/EAN_UCLA_Screening_and_Reporting_ Overview2.pdf

Contact person for more information:

Name: Melanie Gironda, Ph.D.

E-mail: mgironda@ucla.edu

Telephone: 310-825-6544

Unlicensed Facility Fact Sheet and Screening Tool by WISE and Healthy Aging Long-Term Care Ombudsman

Not only do residents in unlicensed facilities not have access to regulations that have been designed to preserve their rights in licensed facilities, they are also more susceptible to abuse and neglect.  This fact sheet and screening tool allows for quick identification of unlicensed care facilities, and referral information to those agencies that handle complaints in these settings.  The tool is designed for and has been distributed to many organizations and agencies including but not limited to:  IHSS workers, APS, ombudsmen, fire fighters, police officers, building and safety staff, regional planning, regional centers, hospital social workers, and department of mental health patients’ rights advocates.

Initial Considerations and First Steps: (MS Word)

www.centeronelderabuse.org/files/Unlicensed_Facility_Screening_WISE.doc

Sample Materials:

Unlicensed Facility Factsheet and Screening Tool (MS Word)

www.centeronelderabuse.org/files/Unlicensed_Facility_Factsheet.doc

Contact person for more information:

Name:  Molly Davies

E-mail:  mdavies@wiseandhealthyaging.org

Telephone: 310-394-9871 ext 431

Creating an Elder Abuse Forensic Center, by University of California, Irvine, Center of Excellence on Elder Abuse and Neglect and the Orange County Elder Abuse Forensic Center

Typically, an elder abuse case requires weeks to months of phone calls among agencies with very distinct, and at times conflicting, perspectives and goals.  Recognizing disconnections between the many disciplines that address elder abuse, the University of California, Irvine School of Medicine, Program in Geriatrics and agencies from social services and the criminal justice system piloted a groundbreaking approach to this problem: the nation’s first Elder Abuse Forensic Center (EAFC) in 2003.  EAFC members meet regularly to determine concrete actions that can be taken on behalf of the client agency (e.g., Adult Protective Services, Long-Term-Care Ombudsman, Law Enforcement) to address the needs of a specific case.  Members use their expertise and agency resources to provide direct help with the case.

Since the Orange County Elder Abuse Forensic Center was established, we have been approached by other communities interested in starting their own Elder Abuse Forensic Centers and assisted in the creation of two new EAFCs.  Based on these experiences, we created a Manual and 20-minute companion DVD to describe how an Elder Abuse Forensic Center (EAFC) works and to help agencies develop a preliminary structure to create an EAFC in their own communities.  Download the Creating an EAFC flyer (pdf) for more information and to order copies.

Sample Materials:

• Sample Case Presentation Format http://www.centeronelderabuse.org/files/CasePresentation.pdf
• Sample Forensic Center Meeting Agenda http://www.centeronelderabuse.org/files/MeetingAgenda.pdf
• Collaborative Agreement for EAFC http://www.centeronelderabuse.org/files/CollaborativeAgreement.pdf
• Medical Assessment Template http://www.centeronelderabuse.org/files/MedicalAssessment.pdf
• Psychological Consultation Report Template http://www.centeronelderabuse.org/files/PsychConsultRpt.pdf
• HIPAA letter from Office of Civil Rights on releasing medical information to Adult Protective Services http://www.centeronelderabuse.org/files/HIPAAGIVES.pdf

Contact person for more information:

Name:  Kerry Burnight, Ph.D.

E-mail:  burnight@uci.edu

Telephone: 714-825-3087

Compiled by the Center of Excellence on Elder Abuse & Neglect at the University of California, Irvine Program in Geriatrics

Thank you so much for compiling and sharing this terrific information! We hope all our readers will share these links and get some of these programs going in your area!