Elder Living

New App “Mind Your Loved One” Provides Storage for Important Information

Today, digital apps provide a means by which we can store and send information on our smartphones and tablet devices. Whether engaging in online banking, using a mobile plane boarding pass, or creating work calendars shared in the cloud, the internet of things provides needed connectivity. Yet critical medical information, health care directives, and other essential legal documents tend to remain in older storage formats such as paper files or on-site at a hospital or doctor’s office. The American Bar Association website displays and recommends an app called Mind Your Loved Ones (MYLO) that provides access to this critical information 24/7.

The app allows you to send information directly to health care providers, whether they be an insurance company, doctor, hospital, or trusted friend or family members, via email, text, fax, or print. Information is not stored in the cloud but locally on the user’s tablet or smartphone for enhanced security.  A mobile app like MYLO falls under the Health Insurance Portability and Accountability Act (HIPAA) scope because it handles personal health information (PHI). The information you want resides on your smartphone, and MYLO has no access to the user’s profile beyond an email address and registered name.

Whether traveling for work, leisure, or living in a retirement community, you can securely store your and your family’s health care advance directives, key medical information like prescriptions, physician contacts, medical notes, and insurance information. There is no need to hunt for paper files or sign onto a website to obtain the information, and you can create as many individual profiles on the app as you want. This immediate access to critical information allows your trusted agent to immediately answer difficult questions that an emergency room or other healthcare professionals ask, creating better health outcomes.

Because you can create an unlimited number of profiles, you can use MYLO to store information on your aging parents, yourself, spouse, siblings, children, and even friends. Each profile automatically generates reports that can be shared electronically with the desired recipient. Insurance information includes copies of both sides of insurance cards. Event notes, routine appointments, prescription changes, activities of daily living, and vital signs can all be maintained and measured over time. A dropbox is available to backup, share, and restore profiles, so even if you accidentally delete or damage a profile, it can be easily recreated. An annual subscription service to MYLO is less than ten dollars.

Other apps provide a format to carry your medical history and records on your phone; however, these apps do not combine legal documents as part of the app. MYLO provides ways to track medical, legal, and other information seamlessly in one app, which is a big plus when under duress to provide information to help yourself or a loved one. Remember that you default your or your loved one’s decision-making to hospital authority without proper legal documentation to make medical decisions.

Keeping all of this critical information current is easy by simply uploading new forms, medical information, insurance data, and legal documents to the app. You will not have to guess which prescription information or legal document is most current as all data storage is by date. A medical doctor can even review previous to current medications to make assessments based on health responses to those prescription changes.

The MYLO app does not mean you have to give up your paperwork if you still like that hard copy in a file cabinet somewhere. Many older individuals like covering all bases with both the standard paper file format and the MYLO app. Time is precious when you or someone you love is experiencing an adverse health event. Quick and easy access to reliable health and legal documentation can help drive the best possible outcome for the situation at hand.

If you or a loved one do not yet have health care directives or powers of attorney for financial decisions, we can help. It’s important to have proper legal advice on what options to choose, and to make sure the document fully represents your wishes. If you’d like to discuss this in more detail, please don’t hesitate to reach out. Please contact our Reno office by calling us at (775) 853-5700.

Elder Living

Seniors Victims of Data Breaches

A staggering 100 million Americans were victims in a Capital One data breach earlier this year, bringing this topic to the forefront of conversations. But what hasn’t been receiving much major media coverage are the recent breaches affecting seniors.

One such breach occurred last year in May, and that breach compromised the personal information of almost 4,000 clients and employees of home care and support services for seniors in the bay area. That “personal information” includes quite a lot, from names, emails, and phone numbers to Social Security numbers, financial records, and health information.

2018 saw three times as many records breaches as in 2017, with 15 million patient records compromised in the healthcare sector. And this issue has only been exacerbated in 2019, with potentially more than 25 million records breached as of July.

Just one security incident in April affected at least 60 facilities in Massachusetts, Minnesota, Missouri, and Tennessee, compromising the personal information an unknown number of patients in those four states.

This is an issue that is becoming increasingly important, in a variety of sectors but especially in the healthcare sector. However, many in this area are ill-prepared to handle it. Data breaches are going on for extended periods, and not being reported within the 60 days mandated by HIPAA.

Part of the problem is that HIPAA is not well equipped to deal with security needs today, in a technological landscape remarkably different from that of 1996 when HIPAA was enacted. Unfortunately, any legislation or regulation enacted today would face a similar problem: technology continues to adapt quickly, and the market pushes the healthcare sector to invest in technological advances as they come.

A few tips to protect your online information: 1) Never open an email from an unknown sender that contains an attachment. 2) When storing information online with a bank or medical provider, make sure you choose a strong password – one that contains a combination of letters, numbers, and symbols that is not easy to guess. 3) Do not store credit card or social security information online.

If you have questions or would like to discuss your planning needs, we would be happy to help. Please contact our Reno office by calling us at (775) 853-5700.

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Elder Living

Be the Best Caregiver You Can Be

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

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

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

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

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

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

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

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

Make sure you have a plan. If something should happen to your health, have you put into writing who should make decisions for you, who should manage your affairs, and what your wishes are regarding your care? If not, the time couldn’t be better. We can help, and would welcome the opportunity to make sure your wishes are properly documented. If you’d like to discuss your particular situation, please contact our Reno office by calling us at (775) 853-5700.

Elder Law, Elder Living, Estate Planning, Healthcare

How Do the Stimulus Payments Affect Medicaid?

The federal government has issued direct payments, “stimulus checks”, to most Americans to invigorate the economy after the devastating coronavirus pandemic. This money is to ease the pain of the Covid pandemic and to jump-start the economy.

The stimulus money should have arrived in the same way that Social Security payments or tax refunds are made, either direct-deposited into a bank account or mailed as a paper check. If the money has not arrived, or for guidance in general, consult the IRS website:

https://www.irs.gov/coronavirus/economic-impact-payment-information-center#more. Other options are to call 800-919-9835 or 800-829-1040, or you can visit your local Taxpayer Assistance Center.

Those who are receiving means-tied government assistance, like SSI, VA benefits, or Medicaid to pay for long-term care, need not worry that stimulus money will be counted against them for eligibility. As long as recipients spend the money within twelve months, the money will not push them over the maximum amount they are permitted before they are penalized.

Recipients may use the money to buy new clothing, cell phones or televisions, toiletries, snacks, dental treatment, or improved quality of medical supplies. They may buy an irrevocable funeral trust, to avoid future expense to family members. They may give the money away to family or charities. The money might pay for updating estate-planning documents, or for consulting a geriatric care manager. (Some commentators believe that you could give the money away to family or charities. While this may be OK under federal law, it’s probably best not to take chances with how the states may interpret it. Spend the money, don’t donate it.)

Provided that the money is not spent on what could be called an asset or an investment – like, for example, rare coins or stocks or bonds – the money will not be counted against the asset limit for Medicaid eligibility. And, again, the money must be spent within twelve months. It must not be forgotten-about or left unnoticed in a bank account.

It also must not be misappropriated by nursing homes or assisted-living facilities. If this has happened to you or your loved one, inform the facility manager that the money must be refunded to the resident. Cite the law that carves out the payment from being counted toward federally assisted programs like Medicaid: 26 U.S.C. § 6409.  Or, show them a handout downloadable from the Congressional Research Service.

If the facility will not refund the money, contact your state’s attorney general. Then lodge a complaint with the Federal Trade Commission.

Recipients of assistance, like anyone else, are free to spend their stimulus money. The money is theirs. It is tax-free. It is intended to be spent, and it should be spent, in any way the recipient would like (subject to the conditions above).

This is one time when spending is unquestionably a good thing – for buyers and sellers.

If you have questions or would like to discuss your situation in a confidential setting, please don’t hesitate to reach out. Please contact our Reno office by calling us at (775) 853-5700.

Elder Law, Elder Living, Estate Planning, Healthcare

American Nursing Homes Face a Dilemma

Our country’s nursing facilities are home to the most vulnerable to the COVID-19 pandemic. When the novel coronavirus did hit, these nursing homes became its ground zero as many residents and workers did not receive testing, and staff found obtaining personal protective equipment a struggle. Some facilities tended to downplay the severity of the outbreaks. Couple these issues with some state governments mandating the reintroduction of recovering COVID-19 patients back into nursing home facilities, and the perfect storm came into being. The Washington Post reports that according to the best estimates, about half of COVID-19 deaths have been nursing home residents. Currently, that half represents more than 52,500 of our senior population.

The Wall Street Journal is reporting that according to two studies, nursing home residents who are dying from COVID-19 on average could have expected to live for another decade. Even the more senior residents, 90 and older, with multiple ailments, are losing more than one year of life. These studies challenge the perception that the coronavirus tends to kill elderly people who were likely to die soon anyhow.

A New Perspective on Elder Care

The coronavirus pandemic is forcing us to take a hard look at where our loved one should receive care if care at home is not a safe option. As the number of nursing home deaths continues to increase, the news media is finding it harder than ever to gloss over the unpalatable reality of these deaths.

Now more than ever it is important for families to come together when a decision must be made about a loved one’s care. We help families discuss options for care and how to plan to pay for appropriate care. If you’d like to discuss your particular situation, please don’t hesitate to contact us. Please contact our Reno office by calling us at (775) 853-5700 with any questions.

Elder Living

Solo aging, Housemates, and Individual Living

In the baby boomer generation, solo aging is becoming more prevalent, but many Americans don’t have family caregivers to assist them in their quest for elderly living independence. The ratio of caregivers to care recipients has fallen and is projected to continue to do so for the next forty years. According to the Pew Research Center, the rate of childlessness among baby boomers is about 20 percent. That number is double the previous generation. Additionally, these boomers who are aging solo, without a spouse or partner and have children living more than 500 miles away, bring the total of solo agers in America to nearly 40 percent of adults over the age of 65.

Because solo agers who own their own home prefer to reside there, many of them are finding creative ways to share costs as well as reduce the workload, stress, and isolation of living alone. Welcome to your new housemate, but don’t call them that and don’t call them roommate either. The boomer generation is adopting the term “POSSSLQ,” (pronounced “possle-cue”) short for People of Similar Sensibilities Sharing Living Quarters. This moniker is a wink at the former US Census Bureau designation for unmarried couples; “Persons of the Opposite Sex Sharing Living Quarters.” Whatever the preferred terminology, this new housemate trend is a demographic and economic shift which is redefining the “golden years” of retirement.

It is no surprise that at a historic shortage of homes pushing up housing costs coupled with the fact that many boomers realize they have not saved nearly enough for retirement has fueled this housemate solution. Some of the best ground rules to follow are to find someone you may already know, perhaps of similar background. Also, keep your “POSSSLQ” in a narrow age range to your own. Seniors who are looking to be housemates and are of a certain age can find each other on websites, some of which are Roommates4Boomers and Let’s Share Housing. It is a great way to stretch retirement dollars and still have independence in a shared living experience without loneliness or feeling like a burden to family.

Women account for most of these new housemate living arrangements. Women tend to live longer and have less in retirement savings as compared to their male counterparts. Women also tend to be more adept at making a home and creating companionable spaces in which to cohabitate.

The rules of roommates are usually broad and general. Some specific ground rules may be non-negotiable such as pets, loud music, or romantic sleepovers; however many women have a more flexible approach and often work out smaller details in day to day conversation. Often the secret to housemate living is to embrace its unexpected nature so long as an established basic framework remains intact. These boomer housemates are expressing creativity in problem-solving issues related to their golden years and want their focus to be on living life rather than the end of life planning.

The cautionary tale of baby boomer housemate living is to be confident you enter into the relationship with a legal document that outlines home ownership, household expenses, chore responsibilities, house rules, as well as identification of objects you already own in your home (if the owner) or what you may bring into the house (as the new housemate). Remember that you spend the first half of your life trying to get something and the second half of your life trying to keep it. Another issue to discuss and lay legal ground rules for is what happens in the case a housemate gets a diagnosis of dementia? A housemate living situation should not evolve into a caretaker situation.

Whether you are the homeowner or the housemate, it is imperative to have a legal document signed and notarized defining the living arrangement. Contact our office today and schedule an appointment to discuss how we can help with the planning and execution of a housemate agreement. Please contact our Reno office by calling us at (775) 853-5700.

Elder Living

The Best Technology for seniors Aging in Place and their caregivers

A big part of American life now includes technology and it is becoming more pervasive in senior populations as the tech industry targets this growing market demographic. A new survey by AARP projects by the year 2030 close to 132 million Americans aged 50 or more will annually spend more than 84 billion dollars on technology products. Today, 91 percent of those aged 50 or more use a computer, and 94 percent say that technology allows them to keep in touch with family and friends. Even smartphone use in older Americans (80 percent) maps out to the same number as the population at large. Also, many parents and grandparents are spending considerable amounts of money on tech-focused gifts for children and grandchildren. Even people aged 70 or more are showing a growing interest in technology and its applications to better their lives.

A Cambria Health survey finds that an estimated 100 million people, 45 percent of the US population, currently care for a loved one and that 64 percent of these unpaid caregivers are increasingly using digital tools to help them. Technology applications are ubiquitous in the paid caregiver world. Applications that are most commonly used include virtual medicine and health trackers worn as digital watches, home automation, motion-sensing devices, medication reminders, GPS devices, and emergency response systems.

The Consumer Electronics Show (CES) held every January in Las Vegas, NV showcases more than 4,400 exhibiting companies from all sectors within the technology industry attended by 170,000 people from 160 countries. The blog, Aging and Health Technology Watch, which tracks industry market trends, research, and analysis, identifies ten intriguing new technologies that currently address the older adult digital tools market. While these are specific to proprietary development companies, there is an expectation as the technology takes off, other tech companies will follow suit. Some of these digital tools are available, while others are not. The booming market for senior technology tools and their associated applications is undergoing very intensive development.

CarePLUS, though not yet available on the open market, uses discreet cameras throughout a household which can detect not only motion but the postures of loved ones. Through the use of artificial intelligence (AI) the system is capable of releasing warning messages in a moment of danger in real time. The artificial intelligence can detect hazards, including falling, sitting for too long, remaining too long in the bathroom, leaving home at an undesignated time, skipping medications, and more. This system reduces the need for multiple individual digital tools by combining many monitoring aspects into one technology product.

The Essence Group Fall Detector Radar is exclusively a multi-sensor fall detection system using Texas Instrument radar technology. Though this product is not yet available, the application programming interface (API) works with Essence’s Care@Home™ monitoring platform for seniors. Radar mmWave (extremely high-frequency millimeter-wave bands) technology tracks a person’s position in their home and provides immediate detection of a fall, alerting healthcare providers. 

For those aging adults with hearing loss, HeardThat™ is capable of turning a smartphone into a hearing assistant by tuning out background noise. Through the use of AI, this technology enables individuals who have hearing loss to more clearly hear speech, allowing them to more fully engage in conversation. The “de-noised” environment can also work with Bluetooth-enabled hearing aids and other listening devices like earphones in conjunction with your smartphone. While this is not yet available an invitation to become involved in the beta testing program and information about a release date is available through their webpage.

AARP Innovation Labs is developing an augmented reality application HomeFit AR™ that enables users to scan a room, discovering what improvements can be implemented to help seniors who choose to age in place have a safer home environment. Appliances such as refrigerators and microwaves, commonly used spaces like sinks and stairs, are identified for specific fixes to put in place that will make a home safer as well as a more comfortable fit for senior living. While the HomeFit AR Guide is still in beta version (part of a software release cycle), the public release date is slated for the year 2020.

Voice-enabled AI is adding integrated voice and conversational intelligence into your digital products using an independent platform that is continuously learning. Houndify™ is a “speech to meaning” engine that can interpret language with unprecedented accuracy and speed. Deep Meaning Understanding™ technology allows a user to ask multiple questions and receive filter results all at once. As the platform is non-brand specific, it can work with your existing device.

A smart remote caregiver solution known as Kytera Companion™ can provide insight into the activity of aging at-home seniors. This home system solution includes data collection, a mobile app for loved ones and a dashboard for professional caregivers. This product can detect both hard and soft falls using a wristband, location sensors, a base unit, and an internet-connected dashboard. Soft falls are the most common type of fall among the elderly and this is the first technology able to assess such a fall. Using AI the system provides comprehensive wellness monitoring that can detect physical and mental deterioration, and be predictive as to evolving disease conditions like depression, dementia, and UTI all based on behavioral symptoms.

Created by physicians and medical device engineers, MedWand™ helps to fulfill the potential of telemedicine. The wand incorporates multiple diagnostic tools in one and is a handheld device. Clinicians are able to conduct remote office visits through the real-time collection of multiple vital sign readings allowing for key patient assessments among numerous medical conditions anywhere in the world.

Orcam MyEye 2 is an advanced wearable assistive technology for the visually impaired or blind. It helps to provide independence by audibly conveying visual information. It can read a text, recognize faces, identify products, and more by simply clipping the device onto your glasses. For the hearing impaired, OrCam Hear is a wearable assistive technology device that uses artificial intelligence, combining lip reading with simultaneous voice separation for better listening. The wireless hearing aid is worn as a necklace with camera modules and microphone sets, allowing for hands-free operation and crisp, isolated voice reception even among crowds.

A companion robot called PECOLA is in development by Industrial Technology Research Institute (ITRI). It incorporates ambient intelligence for the elderly through the collection and analysis of the user’s life and physiological data. It is capable of detecting abnormal behaviors of a loved one allowing for preventative rather than responsive healthcare which can provide best outcomes. By following the senior around their home, PECOLA can identify emotions as well as perform video-generated diet analysis and fall detection. It can conduct sleep assessments through breathing and heart rate readings. The daily generated activity reports are then automatically provided to the user’s caregiver.

The Zibrio SmartScale is available for pre-order and enables a home user to measure and track their balance with a safe and simple 60-second test. The test itself is eyes open, stand still for 60 seconds while the scale assesses balance and provides a score (1-10); the lower the score in seniors 65 or more, the higher the risk for falls. This scale also provides personalized insight into lifestyle factors that affect your balance. 

Other notable new products are available for review at these websites:

Digital technology innovation specifically designed to address older adult care needs provide new ways for seniors to age in place successfully. Consultation with your healthcare providers as to what systems they employ can help synchronize your healthcare and reduce doctor office visits through the use of telemedicine and at-home monitoring. It also can provide unpaid caregivers reliable, real-time information about a loved one’s well-being that can help reduce stress on the part of the caregiver.

If you are caring for a loved one, please give us a call to see how we can help to ensure that the proper legal documents are in place for you and your loved one. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact us. Please contact our Reno office by calling us at (775) 853-5700.

Elder Law, Elder Living

Seniors Stay Socially Engaged While Socially Distancing with the help of Technology

We have come to know that successful, healthy aging is contingent upon connection to those around us. The opportunities for people to laugh, move, and learn together is foundational to aging success. Enter the coronavirus pandemic to change all of that. Now aging Americans must stay socially engaged while maintaining a physical distance. This issue touches us all from senior wellness professionals, medical staff, families, inter-resident connections, and those aging in place at home and alone. The internet of things, and the virtual links it creates, is a great solution to implement in a socially distanced, troubling pandemic world.

Virtual technology tools were becoming more ubiquitous before the coronavirus. Yet, the need for emotional well-being as the especially vulnerable aging population of America became isolated was the accelerant solution to address the problem. Fitness classes ranging from tai chi to yoga and other forms of movement became available in droves of senior online classes. Connecting with family members or health professionals through telemedicine also became crucial as regular visitations and routine medical appointments became impossible.

Virtual tools provide a great advantage for social distancing as no meeting space is required. Senior interaction with tech tools has brought new learning and skills opportunities, providing a sense of connection, purpose, and pride. Older adults share their newfound prowess in video messages, multi online person chats, and more. Grandparents and grandchildren find common ground in a technological world, and grateful parents/adult children are happy for the means to address the social isolation problem and create stronger inter-generational family ties.

Beyond the connection of friends and family, technology brings email, instant messaging, social media sites, brain games, wellness bingo cards, music, even virtual cruises with daily ports of call to keep seniors connected in isolation. Many aging adults associate full-length feature films with a movie theater and do not realize they can watch nearly anything they want via streaming services, 24 hours a day, whenever they choose.

While the internet and these technology tools provide virtual interaction and entertainment, not every senior who needs it can afford a tablet computer or laptop. Many communities are holding campaigns to raise funds for those in need of these digital devices. Nursing homes can receive a stipend from the Centers for Medicare and Medicaid (CMS) through the Civil Monetary Penalty (CMP) fund. Funding through CMP provides communication aids such as tablet devices and webcams that enable virtual visits. However, each facility has a limit of $3,000 to ensure a balance in distributing CMP funds. Because these items may be shared among negative COVID-19 residents, it is critical to avoid entering highly personal information into device applications or programs. Shared tablets are not a good way to check bank accounts, shop online, or have your senior pay bills.

Be wary of too much learning too quickly for a senior. Don’t overwhelm the aging adult with the technology, rather focus on what it provides. Slowly introduce different aspects of the technology and be certain the senior has a firm understanding of how to repeat the process to get online or risk creating frustration. Also, educate them that even though they can Skype, Zoom, et al. with others does not mean their loved ones or friends will be available at all times for them. Set a schedule for meaningful connections, managing their expectations to keep them from cycles of disappointment. Share successes, experiences, even failures with residential staff, other family members, and residents. Find out what works the best overall. Keep the strategy simple for the best results.

Be aware that seniors without strong social connections before covid-19 may feel incredibly left out. The technology connecting people doesn’t work if there is no one to communicate with on the other end of the virtual line. Residents without existing social networks typically rely on the now non-existent shared dining room and community events for interaction, and they may now be left behind. These residents need more assistance in learning how to join online classes and interactive communities that share like interests. Senior Americans unfamiliar with the internet of things do not understand the scope of what is available to them. CMS Administrator Seema Verma states, “While we must remain steadfast in our fight to shield nursing home residents from this virus, it is becoming clear that prolonged isolation and separation from family is also taking a deadly toll on our aging loved ones.”  Help your loved one to leverage digital technology and the internet to stay connected during the coronavirus pandemic. There is still hope and human connection available, and vulnerable and isolated seniors are in desperate need of both.

If you have questions or would like to discuss your personal situation, please don’t hesitate to contact us. Please contact our Reno office by calling us at (775) 853-5700.

Elder Living

Understanding CMS Guidelines for Nursing Home Visitation

Revised guidance for nursing home visitation has been issued by the Centers for Medicare and Medicaid (CMS). It is now possible to have visitation with nursing home residents for reasons other than urgent end-of-life scenarios and, in some instances, may include physical touch. Additionally, communal activities and dining are permissible as long as the social distancing rule of 6 feet of separation, and other precautions are observed. Encouraging outdoor visits is desirable as long as the weather permits. Indoor visits are permissible if no new cases were identified in the previous two weeks, and the facility adheres to the core principles of resident and staff testing, screening, proper hygiene, social distancing, and facility cleaning. 

The CMS memo contains “Core Principles of COVID-19 Infection Prevention” verbatim as follows:

  • Screening of all who enter the facility for signs and symptoms of COVID-19 (e.g., temperature checks, questions or observations about signs or symptoms), and denial of entry of those with signs or symptoms
  • Hand hygiene (use of alcohol-based hand rub is preferred) 
  • Face covering or mask (covering mouth and nose) 
  • Social distancing at least six feet between persons 
  • Instructional signage throughout the facility and proper visitor education on COVID19 signs and symptoms, infection control precautions, other applicable facility practices (e.g., use of face-covering or mask, specified entries, exits, and routes to designated areas, hand hygiene)
  • Cleaning and disinfecting high frequency touched surfaces in the facility often, and designated visitation areas after each visit 
  • Appropriate staff use of Personal Protective Equipment (PPE) 
  • Effective cohorting of residents (e.g., separate areas dedicated COVID-19 care)
  • Resident and staff testing conducted as required.

CMS acknowledges that the previous months of severe visitor restrictions to slow the spread of COVID-19 were at a high cost to nursing home residents’ overall wellbeing. The revision of visitor guidance compassionately addresses resident care needs beyond protection from the coronavirus. CMS Administrator Seema Verma states, “While we must remain steadfast in our fight to shield nursing home residents from this virus, it is becoming clear that prolonged isolation and separation from family is also taking a deadly toll on our aging loved ones.”

CMS is also making available Civil Monetary Penalty (CMP) funds to ensure greater and safer access to outdoor and indoor visits. The money can purchase tents for outdoor interaction and clear dividers such as plexiglass can create physical barriers, reducing the risk of transmission during in-person visits. Funding through CMP can also provide communication aids such as tablet devices and webcams that enable virtual visits. However, each facility has a limit of $3,000 to ensure a balance in distributing CMP funds.

Compassionate care situations now include more than the end-of-life scenarios and are also included in the CMS memo. Verbatim they include but are not limited to:

  • A resident, who was living with their family before recently being admitted to a nursing home, is struggling with the change in environment and lack of physical family support.
  • A resident who is grieving after a friend or family member recently passed away.
  • A resident who needs cueing and encouragement with eating or drinking, previously provided by family and/or caregiver(s), is experiencing weight loss or dehydration.
  • A resident, who used to talk and interact with others, is experiencing emotional distress, seldom speaking, or crying more frequently (when the resident had rarely cried in the past).

In addition to family members, compassionate care visits may now also include clergy or laypersons offering religious or spiritual support that meet the resident’s needs. Personal contact is permissible during these and family visits but only when following all appropriate infection prevention guidance. This more humanized approach to nursing home care encourages facility staff to work with residents, families, caregivers, and resident representatives to identify those in need of in-person compassionate care visitation. Exceptions to compassionate visits occur when facilities have experienced COVID-19 infections within the past two weeks or when a county is experiencing a high positivity COVID-19 rate. In the absence of a reasonable safety or clinical cause, the Centers for Medicare and Medicaid make clear that failure of nursing homes to facilitate in-person visitations can be cause for citations and other penalties as CMS deems appropriate.

CMS understands that nursing home residents derive physical, emotional, and spiritual value and support through family and friend visitations, especially in trying times. No one should be made to endure this pandemic alone, least of all the most vulnerable among us. This new CMS nursing home visitation guidance is designed to help American seniors remain happier, stronger, and more resilient in the face of adversity through the personal support of those who love them most.

If you have a loved one in a nursing home, check with the facility to see how or whether their visitation guidelines have changed. It may take time for local facilities to consider these new guidelines and make changes that are consistent with the recommendations from CMS.

We would be happy to discuss any questions you have, including how to choose appropriate long term care and how to pay for it. We can recommend legal ways to help ease the cost of long-term care and protect your savings and home. Please contact our Reno office by calling us at (775) 853-5700 to learn more about your legal options.

Elder Living

Among Elderly Americans, Isolation is Increasing Self-Neglect

Because of the coronavirus, our elder population is experiencing isolation from their family and extended community interaction, increasing the likelihood of neglect. With the flu season fast on approach this isolation and the possibility of a resurgence of COVID-19, older Americans will likely continue living 2020 in mostly solitary circumstances. Rising instances of loneliness can give way to clinical depression and foster feelings of hopelessness.

Common Signs of Self-Neglect

Some of the common signs that an older adult is self-neglecting include changes in how they communicate and a lack of interest in family or community events. A loved one who always presented themselves in a put-together manner may suddenly stop bothering to dress for the day, or perhaps they have gained or lost a startling amount of weight. A once tidy home may now be piled high with unopened mail and heaps of garbage. They may stop or have difficulty managing their medications. Their demeanor and mood may change, and often there is the incidence of a fall.

ASA

Neglect is often a person depriving themselves of necessary care, whether it be adequate nutrition and hydration, medical care, hygiene, and a suitable living environment. In some instances, neglect may be an extension of diminished capacity of physical or mental ability to provide self-care. In some cases, negligence can be the precursor to abuse by an active or passive negligent caregiver. As reported by the American Society on Aging (ASA) outside of financial abuse, the National Association of Professional Geriatric Care Managers identifies self-neglect as the more commonly encountered situation than physical or sexual abuse or neglect by others.

Each state has a mandatory reporting law requiring certain people to provide information about suspected abuse to the proper authorities. Typically, these people are nurses and doctors, as well as wellness check programs through CMS services. Some states require any person who suspects elder abuse to report the situation. Know your state law for reporting and be mindful that your elder loved one is isolated from medical professional groups who report signs of neglect.

What to Do if you Are Suspecting Elderly Abuse

If you have not already implemented virtual strategies to combat loneliness for your older adult, do so immediately. There are many communication, safety, health, and entertainment apps designed specifically with seniors in mind. If your loved one cannot manage a smartphone, use a larger tablet device. If that is unachievable, get a smart speaker where voice communication can provide the sorts of contact options, safety, and activity your senior needs.

Contact your loved one routinely. Implement fall detectors and set up video surveillance to identify any problems. Be sure not to create an overly invasive system allowing your senior some degree of privacy to protect their dignity. Always use firewalls, passwords, and other security options to address privacy concerns.

Take advantage of community programs such as Meals on Wheels or identify programs that check-in on independent living older adults or high-risk households. If they are so inclined, set up the technology for your family member to participate in the many religious services currently being conducted live on Facebook. Connect with their neighbors or local friends to request they occasionally check in on your family member.

AARP recommends whatever the legal obligation in your state to report any sign of elder neglect or abuse. If you believe the person may be in imminent danger, call 911 immediately. If not, address the concern with the person directly or with their caregiver or family member. Remember, you may be misinterpreting the situation. After you have raised your concerns, listen carefully to the other person’s point of view. There may be a quick fix for a small problem, or it could be something more profound. Act deliberately but with compassion. If you meet with resistance to change but still believe help is needed, learn how you can report your concern. Your local police department may have an Elder Affairs unit. Nationally, you can contact support through a public service of the US Administration on Aging called the Eldercare Locator (800-677-1116), connecting you with local protective service agencies.

If you believe your loved one can no longer manage their health, safety, and wellness needs, we can help by providing advice on legal options to protect your loved one. We would be honored to talk with you. Please contact our Reno office by calling us at (775) 853-5700 to learn more.