Elder Living, Healthcare

Termination of Home-Health Care Services Is Becoming More Common

Many Americans are getting their Medicare benefits cut as home health providers, including occupational, speech, and physical therapists, social services, as well as skilled nurses are saying: “Your husband (or whomever) is not going to get better, so we will have to discontinue our services as Medicare will not pay for it.”  Termination of care is swift, often within 48 hours of delivering the message, and the home health care chores fall to the family system or must be paid for out of family funds. So what changed?

PDGM Figure 1

Significant changes began on January 1, 2020, as to how Medicare pays for home health services. Medicare has altered its billing approach from a therapy delivered model (the more therapy you receive, the higher the payments billed to Medicare) and changed it into a reimbursement system known as the Patient-Driven Groupings Model, or PDGM. Medicare Advantage plans have separate rules and are not affected.

The Centers for Medicare and Medicaid Services (CMS) provide Figure 1 as an example of how a 30 day period becomes categorized into 432 case-mixed groups for adjusting payment purchases in the PDGM. These 30 day periods are further broken into the following subgroups: admission sources and timing, twelve clinical principal diagnosis subgroups, three functional impairment levels, and three levels of co-morbidity adjustments. During the 30 days, there is only an allowance for one chosen category under the larger color-coded categories. CMS deems this newer approach to be more holistic regarding patient need assessments.

In 2017, the most recent year for which the data is available, for-profit US home health care agencies (approximately 12,000) provided care to 3.4 million Medicare beneficiaries. Home health rates charged were based on the amount of therapy delivered. The more therapy a patient received, the higher the payout to the agency. Due to the change in payment structure, these agencies are cutting back on therapies provided and even reducing the number of therapists employed. They can’t bill enough to Medicare to remain profitable. These new payment conditions are based on a patient’s underlying diagnosis and other case-specific complicating medical factors. As a result, home health care agencies now have a stronger financial incentive to meet the needs of short-term therapy, post-hospital or rehab facility, as well as caring for patients requiring nursing care for complex situations like post-surgical wounds.

CMS believes this new way to assess payments will strike a balance between costs, efficiencies, needs, and outcomes. The members of the National Association for Home Care and Hospice (NAHC) disagree. Data culled by NAHC from home health agencies indicate there will be a substantial reduction of therapy services offered as a result of the PDGM. William Dombi, the association’s president, states that the cuts “may not be a good move” because medically, patients may deteriorate more rapidly without therapy and seek aid in emergency rooms or hospitals.  He also notes the possibility that if more patients end up worse off and go to emergency rooms or hospitals, that this will reflect poorly on home health agencies and can affect their referrals.

Providing the right patient therapy at the right time by home health care agencies is critical to positive patient outcomes. CMS has done extensive analysis of historical data and, through the use of artificial intelligence tools, feel they can better predict what kind of services and how often a patient will need them through the PDGM. Clarifications are being posted online by CMS that deal with early errors in the program and the ensuing turmoil of therapy provision for patients within the new guidelines. It is the hope that more reviews and revisions to the PDGM will strike a better balance between cost and efficiency, patient therapy needs, and outcomes.

Understanding the role Medicare will play when it comes to long term care services can be confusing. We help families plan for the possibility of needing long term care, and how it could be paid for without causing the family to spend everything they have. 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

Protections from Spousal Impoverishment

There are laws that were put in place to protect married couples’ savings from being depleted when using Medicaid. These protections prevent husbands and wives from bankrupting themselves trying to fund care for their loved ones. They originally required states to allow spouses of nursing home residents to maintain a certain amount of both income and assets; in 2014, this protection was extended to married couples whether the care is provided in an institution or at home.

These protections are set to expire in September unless new legislation is passed. If these protections are not extended, some married couples would be at risk of losing their Medicaid coverage unless they enter a nursing home.

Forcibly separating families, forcing individuals to institutionalize their spouses, is a tough policy. Congress should therefore extend these protections. Fortunately, Sens. Amy Klobuchar (D-MN) and Tina Smith (D-MN) would make these protections permanent.

“When you’re caring for a loved one round-the-clock and serving as your spouse’s support system, you’ve probably already worried about how to make ends meet. You shouldn’t have to worry about your savings completely drying up,” Smith said. “Our bill would make spousal impoverishment protections permanent so families can stay together and get the care they need, surrounded by the people they love.”

This particular bill is mostly supported by Democrats, including Richard Blumenthal (D-CT), Sherrod Brown (D-OH), Bob Casey (D-PA), Kirsten Gillibrand (D-NY), Jeanne Shaheen (D-NH), Debbie Stabenow (D-MI), and Chris Van Hollen (D-MD). Several of these supporters

A similar bill, H.R.1343, was introduced to the House in February by two Republicans, Reps. Debbie Dingell (D-MI) and Fred Upton (R-MI).

In the meanwhile, H.R.3253, which would extend the applicability of Medicaid eligibility criteria that protect against spousal impoverishment for recipients of home- and community-based services, passed in the House and is now in the Senate.

If you have questions or would like to discuss your personal situation, please don’t hesitate to contact our Reno office by calling us at (775) 853-5700. You can also read more using the links below.

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Elder Living

The Benefits of Tech Apps to the Senior Population

Changes in technology are occurring continuously and it may seem hard to keep up. For many seniors, these changes can be so daunting that they tend to avoid technology altogether.

While seniors have increasingly embraced technology in recent years, data from Pew Research shows that as many as one-third of those over the age of 65 do not use the Internet, and nearly half do not have home broadband services.

Still, technology can be a key aspect of keeping seniors — who tend to spend more time alone than their younger counterparts — engaged and connected. It can also help caregivers to stay connected to their patients or loved ones.

Let’s take a look at some of the benefits of tech apps for the aging population.

Staying connected. Social connections are healthy for people of all ages, and this can be especially true for seniors. While there is no substitute for human interaction, technology can help to fill the gap for seniors who are away from family members or friends. Whether in person or online via video or messaging technology, social interaction can potentially lower blood pressure and reduce the risk of cardiovascular disease and Alzheimer’s, according to medical professionals. Apps such as Facebook and Instagram can help seniors connect with loved ones and caregivers.

Keeping active. There is no shortage of apps to help people stay active these days and seniors can certainly benefit from this technology. For those who can no longer drive or who do not have a neighborhood rec center with fitness classes, technologies such as those provided by the Nintendo Wii can help to get seniors moving wherever they are. Whether it’s tennis or yoga, these apps also offer fun activities for seniors and their loved ones or caregivers to do together.

Staying mentally sharp. Mental exercise is just as important as physical for the elderly. We’ve all heard how crossword and Sudoku puzzles can help thwart memory problems, but today there are countless other online games and mobile apps seniors can use to help stay mentally sharp. Not only can seniors do a crossword puzzle on the computer or mobile device, but they can also play solitaire, trivia, and memory games.

Managing medical records and medication. Today just about every doctor’s office offers records and correspondence online. This makes it easier for seniors to keep track of appointments and health records. There are also plenty of apps available — such as Medisafe — to help seniors keep track of medication dosing, schedules, and pharmacy refills. These types of apps help seniors make sure they don’t miss a dosage or inadvertently double up on medication if they’re having trouble keeping track due to memory problems or illness.

Keeping seniors safe at home. Most seniors want to retain their independence for as long as possible. That means remaining in their own homes as they age. By using technology they can better ensure their safety and their loved ones’ peace of mind while remaining independent.  Seniors living alone should always have some type of personal emergency response system or PERS. These are devices that help a person call for help by pushing a button, and connected mobile apps can alert family members or caregivers in the event of an emergency. These technologies activate the appropriate emergency response, helping seniors to avoid the frightening situation of trying to handle a medical or another emergency on their own and giving their loved ones peace of mind.

Managing finances and bills. Seniors are often reluctant to hand over the reins when it comes to managing their budget and finances. Maintaining that control helps instill a stronger sense of independence. Apps like Mint can help seniors manage these tasks and help ensure due dates aren’t missed or payments aren’t overlooked altogether. These apps can also help caregivers maintain a repository of their loved one’s budget and financial obligations.

While tech apps can seem daunting for seniors (48 percent of those over 65 say that they need assistance using new technologies and devices), with the proper support and training they can be a powerful tool for helping seniors maintain their health and independence.

If you’d like to learn more about empowering yourself and your loved ones with proper care and planning, our firm can help. Please contact our Reno office by calling us at (775) 853-5700.

Elder Law, Elder Living

Medicare Scams and How to Avoid Them

Insurance companies are frequently subject to being scammed. Scammers frequently target government insurance like Medicare by stealing newly issued medical ID cards and then stealing identities. The Coalition Against Insurance Fraud estimates that tens of billions of dollars are lost annually to these types of fraud. Additionally, medical identity theft is now a top complaint received by the Federal Trade Commission. Billing fraud is also responsible for huge losses to Medicare funds and is difficult to assess as it can be a billing error or intentional fraud.

How does this affect a senior on an individual level? Scammers typically pose as Medicare officials and ask people to pay for their new cards which in reality are free. Or they phone a potential victim with false news of a refund and ask for the person’s ID number and bank account number to deposit the refund. “Right now … everyone is being inundated with TV commercials, brochures, and other official-looking documents in the mail about all the Medicare Advantage plans. It’s so confusing, and in an environment like that, fraud is rampant,” says Micki Nozaki of the California Senior Medicare Patrol. There are more than 50 million Medicare beneficiaries who can annually opt to swap Medicare Advantage and Part D prescription drug plans which provide scammers with the opportunity to prey on vast numbers of seniors.

The Centers for Medicare and Medicaid Services have a list of tips to help prevent fraud. The first and foremost is to protect your Medicare and Social Security numbers vigilantly. It suggests treating your Medicare card like you would a credit card and do not provide the number to anyone other than your doctor, or people you know should have it. Become educated about Medicare with regards to your rights and what a provider can and cannot bill to Medicare. Review your doctor bills carefully, looking for services billed for but not provided to you. Remember that nothing is free with regards to medical care; never accept offers of money or gifts of free services. Be suspicious of your provider if they tell you they know how to “bill Medicare” to pay for a procedure or a service that is not typically covered. Before leaving your pharmacy check to be sure your medication is correct, including the full amount prescribed and whether or not you received a generic or brand name medicine. If your prescription is in error report the problem to the pharmacist before leaving.

Remember Medicare will never visit, call, or email you and ask for personal information such as your Medicare number, Social Security Number, address, or bank account number. Medicare already has this information and does not need you to provide it. Even when Medicare issues new cards that no longer contain your social security number in April of 2019 you will not be required to do anything. You can assume that anyone who claims to be helping you with Medicare and asks for your personal or financial information is a scam artist so close the door, hang up the phone, or delete the email.

When it is time to compare plans be sure to meet with a trustworthy advisor. Some insurance representatives give the industry a bad name by selling you a policy or plan that does not suit your needs or your budget. Some agents go so far as to ask you to sign a release form allowing them to make decisions on your behalf. Never sign anything related to Medicare without first reading it carefully. Additionally, it is a good practice to have a family member or lawyer review the document before signing it.  The non-profit National Council on Aging (NCOA) has a free, brief assessment that allows you to compare plans online. You can also contact your local State Health Insurance Assistance Program (SHIP). SHIP is a provider of free, federally-funded Medicare counseling via a trained volunteer or staff member.

Medicare fraud wastes billions of taxpayer dollars annually. Carefully review your medical bills and have inaccuracies corrected. Guard your personal information vigilantly and be wary of people asking you to provide that information. Meet with a trusted insurance advisor or compare medical plan options using the sites listed above. If you are unsure about something call Medicare directly for clarification.

If you have questions or would like to discuss anything you’ve read, please don’t hesitate to contact us. Please contact our Reno office by calling us at (775) 853-5700 with any questions.

Elder Law, Elder Living

Nursing Homes and COVID-19 Deaths

Because aging Americans are more susceptible to the coronavirus, deaths in this age group are high. Although nursing home residents are less than one percent of the total US population, according to a report from the CDC, they account for more than 40 percent or approximately 45,500 of the US 115,000 COVID-19 deaths.

Seema Verma, the administrator for the Centers for Medicare and Medicaid Services (CMS), asserts that nursing homes following federal infection control guidelines were largely able to contain the coronavirus.

Harvard researcher David Grabowski, a member of a nonpartisan commission, advising Congress about Medicare, states that “The federal government needs to own this issue,” about the need for federal efforts to routinely test nursing home staff and residents for COVID-19 and make more protective gear available. Grabowski agrees with other advocates for the elderly that the federal government has not provided consistent virus testing and sufficient protective equipment to nursing homes, its staff, and residents.

High Risk for Elderly Care During This Election Year

In this Presidential election year, the stakes could not be higher to garner support from older voters. Partisan overtones affect the discussion and subsequent policies to guide safer nursing home outcomes from the ravages of COVID-19. The blame game is on between political parties fighting for votes and states legally protecting health care workers and facilities from coronavirus lawsuits by residents or their families.

The Trump administration deflects accountability by criticizing nursing home facilities with low federal ratings for infection control and a handful of Democratic governors, New York in particular, who mandated that nursing homes accept recovering coronavirus patients. The number two House Republican, Steve Scalise of Louisiana, states that this NY policy, and other states with similar policies, “ended up being a death sentence.” Verma echoes the nursing homes with low federal rating criticism, saying CMS has data equating low safety ratings with outbreaks of COVID-19. Several academic researchers dispute this data citing their research has found no such link. Amid the finger-pointing, shamefully, more vulnerable senior nursing home residents are dying because of the coronavirus.

Nursing Home Concerns During Coronavirus

In agreement with other academic researchers, Harvard’s David Grabowski opined that neither state policies nor proverbial bad apples among nursing homes were responsible for driving the coronavirus outbreaks. The reason is simply because of the virus’s nature, which can spread via individuals displaying no symptoms and do not feel unwell. The illness’s very nature indicates it is already spread throughout communities. Without routine testing, nursing home staff can unknowingly bring COVID-19 into a facility where it then spreads easily among frail residents living in tight quarters. Ricardo Alonso-Zaldivar of the Associated Press quotes Grabowski, “The secret weapon behind COVID is that it spreads in the absence of any symptoms,” Grabowski told lawmakers at a recent briefing. “If COVID is in a community where staff lives, it is soon to be in the facility where they work.”

Advocacy group Justice in Aging’s long-term care expert Eric Carlson cites the lack of federal coordination as impeding the ability to identify people who are infected by and require care for the coronavirus. Other advocates agree that the White House directive for the testing of all residents and staff has had an uneven response, accounting for why some facilities suffer higher rates of infection than others. The Associated Press report from the end of May 2020 concurs with these opinions reporting “White House goal on testing nursing homes unmet.”

Meanwhile, at CMS, administrator Verma believes her agency has provided necessary safety guidelines, COVID-19 reporting requirements, and Medicare payment for testing residents since the outset of the virus. She continues that states have the money required from the federal government to support the nursing home staff’s testing. Let’s hope that is the case, as the nursing home industry reports one-time testing for every resident and staffer would cost 440 million dollars.

The coronavirus pandemic is not going to go away. New spikes of cases across the country are being reported and not even considered the “second wave” of infection that many experts anticipate. Third-ranking House Democrat Representative and chairman of a special panel on the coronavirus pandemic James Clyburn of South Carolina seems to match wisdom with temperance about the finger-pointing saying that the crisis in nursing homes should not be a partisan issue. Instead, stating, “Nursing home residents have died from the coronavirus in states governed by Republicans and Democrats, in big cities and in small towns, in rural and urban communities.” Capitol Hill law and policymakers seem to be very adept at identifying problems but slow in resolving them. In the meantime, our vulnerable senior nursing home population and their families are paying the price. We help families with loved ones in a nursing home deal with a variety of issues. If you have a loved one in a nursing home, please don’t hesitate to reach out to see how we can help. Please contact our Reno office by calling us at (775) 853-5700.

Elder Living

Silver Bills Help Seniors With Their Bill Paying Process

Silver Bills is a service that assists seniors in the process of paying their monthly bills. As many baby boomers continue to opt for aging in place, home administrative tasks can become problematic.  Family members who would like to help may live out of state or are too busy in their own careers to manage a loved one’s household bills. SilverBills has created a seamless service that will receive your bills, carefully review them, and ensure that your bills are correctly paid.

At your direction, SilverBills will mail you an enrollment packet. You will have to provide bills and one voided check to SilverBills in the envelope they provide. Once SilverBills receives the envelope they will convert your bills to “ebills”. Once enrolled in the service you will have a dedicated customer service representative that will assist you with any concerns or questions. SilverBills service will now receive, review, and ensure that your bills are paid for properly. The service guarantees that you will not incur late fees or penalties. In the event you do the service charge or late fee will be paid for by SilverBills.

No more getting to the mailbox or PO Box on a regular basis to look for bills. No more US Post Office trips to purchase stamps. No more calendaring due dates of bills and check writing. Once a month you will receive a statement showing your bills have been paid. There are no contracts; you can cancel your service at any time. SilverBills uses the same 256-bit encryption used by banks so that your transactions are secure.

Automating your bills through a bill-paying service is becoming more commonplace particularly for seniors 75 and older. It is easy for a senior to mistakenly pay a bill twice or not at all and have needed electricity or water services shut off. The ability to manage money is often one of the first skill sets that go when someone is experiencing mild cognitive impairment. By the time a person reaches their seventies, there is a 20 % chance of cognition troubles. That percentage increases to 50% in our eighties.

SilverBills is one of a growing number of daily money management companies. The services are typically expensive ($100 and up, per month) but the peace of mind a family can have knowing the day-to-day bills are being correctly handled is worth the price to many. The American Association of Daily Money Managers is an online resource that can help you find the right professional service for you or your loved one. Always ask for references and check accreditations before allowing access to your banking information and remember these bill-paying services do not act as accountants or financial advisers. They are more akin to a personal financial assistant with the added bonus of consumer advocacy; looking for bill errors and potential fraud.

There are many reasons that accurate bill-paying becomes unmanageable for seniors. SilverBills and services like them are becoming increasingly popular for proper bill payment. Talk with your family or trusted counsel to see if it is the right choice for you. Feel free to contact us if you have any questions or would like help with your planning needs. Please contact our Reno office by calling us at (775) 853-5700.

Elder Living

Older Americans are Experiencing Higher Levels of Bankruptcy

Many retired and older Americans are filing for bankruptcy at higher rates than ever before. While medical advances are keeping seniors alive longer, the associated healthcare costs in the quest for longevity are being off-loaded onto the older individual at a time when reduced income is a hallmark of senior living.  Older Americans are increasingly filing for consumer bankruptcy. According to the Consumer Bankruptcy Project, the population aged 65 or more is filing for bankruptcy at a two-fold increase, and there is nearly a five-fold increase in the percentage of seniors in the US bankruptcy system. The economic risk for seniors is running rampant, and the sad truth is currently 97 out of 100 people aged 65 and over are not able to write a check for $600 or more due to insufficient funds.

The sentiment among Americans is that their standard of living will increase at the age of retirement when it is quite the opposite. The typical retiree has set aside about $60,000 for their old age living, and more than 50% over the age of 55 have saved less them $50,000; as much as 40% of these workers have less than $25,000 set aside. The stark reality is none of these “nest eggs” are enough to see a senior through old age and the unforeseen disasters that can deplete what little has been saved.

One of the more common financial obstacles that create this bankruptcy scenario is a health issue. Medicare is not comprehensive. In the absence of a supplemental insurance plan picking up the non-Medicare funded 20 percent cost, a senior can be left with unforeseen operation and rehabilitation costs. Without full health care coverage, the cost of staying alive as a senior is practically prohibitive between prescriptions, treatments, surgeries, rehabilitation, and assisted care. The primary two options available to a senior to cover these costs of survival are credit card debt and loans.  Suddenly, at a time when most seniors should have very low monthly living costs, they find themselves back in a debt slave scenario with little or no income to address their healthcare debt. 

Many seniors have concluded that retirement is not a part of their future as they will need a viable stream of income to avoid financial disaster. While this seems reasonable, it is not a good plan to assume one will be healthy enough to work forever. As we age, there is an increased probability that working will become impossible due to unforeseen illnesses. When this happens, debts begin to mount, and bankruptcy becomes a likely result. Additionally, the era of stable pensions afforded to a long-time employee has gone by the wayside. Fewer companies even offer them anymore and those that do often modify and reduce pension benefits to meet corporate expectations of financial profits.

The cost of living rarely if ever is reduced over time and while social security benefits seem like the answer to a senior’s retirement years; these benefits seldom cover basic living expenses no matter how long an individual may have worked or how much they paid into the system. The senior who is faced with government social security benefits and very little additional income usually turn to credit cards to address the gap between low income and living expenses. This scenario takes a senior right back to debt slave mode. As many as two out of three seniors who file for bankruptcy cite credit card debt as one of the primary reasons.

Scams that target the senior population are becoming more sophisticated and prolific with the advent of technology. What used to be a “one to one” scam can now be distributed via email to thousands of targeted seniors who are online in greater numbers than ever before. Often the unsuspecting senior will make passwords or personal bank information available to what they believe is a legitimate request for information from what appears to be a valid email. Seniors can also fall prey to predatory lenders as many seniors cannot read the fine print or understand the consequences of their actions. When scam artists victimize a senior, the senior often lose a large chunk of their assets which in turn can put them in a bankruptcy scenario.

While it is impossible to know the exact future, it is possible to make reasonable plans for it. Learn the ways that you can protect yourself from becoming part of these bankruptcy statistics in your senior years. Even a modest plan is better than no plan at all. Seek the advice of trusted legal and financial professionals to help you understand what you can do to protect your future. Please feel free to contact our office today to discuss how we can help you with your planning. Please contact our Reno office by calling us at (775) 853-5700.

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Elder Living, Healthcare

Don’t Wait for a Crisis to Discuss Long-Term Care With Your Parent

It is unclear whether or not your parent has a plan in place for long-term care. It is a difficult topic to broach; no one wants to talk about death and the financial realities that come with aging.  Instead of having a proactive conversation early in a parent’s aging process, most families have a reactive discussion under high levels of stress and emotions while their parent is experiencing an adverse health event.  The Public Broadcasting Service (PBS) has reported that 85 percent of the time long-term care decisions are made during a medical crisis. The message is clear, be proactive and start discussing the important financial questions with your parent.

Prepare Yourself

Your parent will feel more comfortable and at ease if you have processed your feelings before talking to them.  Conduct research so that you are knowledgeable enough to present a clear and concise set of options for your parent.  Having options allows your parent and family to make decisions and feel in control of the process.  You are seeking progress, not perfection. It may not all become settled in one conversation, but the price of silence about your parent’s plan may be very costly to you.

Review Documents

Two of the most critical personal legal documents are a durable power of attorney (DPOA) and a healthcare proxy. All older adults should have these documents as it gives legal authority to a designated representative to make financial, legal, and health care decisions on your parent’s behalf. If your parent does not have a DPOA and becomes incapacitated, you will have to go to court to get appointed as your parent’s guardian which can be a complicated legal process at a time when your energy is better spent in the care and decision making for your parent. If they do not have a DPOA and health care proxy in place make arrangements for them to meet with a trusted elder law attorney to properly draft the legal documents.

Often a parent will have a will, retirement account information, and insurance policies that have not been revisited or updated in years, sometimes decades. When was the last time your parent reviewed beneficiary designations? Family circumstances change, and the birth of a child, death, or divorce can affect how your parent may want beneficiaries designated. It is best to review financial and insurance data annually with your parent and make adjustments if necessary. For example, if the parent’s children are grown it might be best to cut back on the amount of life insurance they carry to save money on annual premiums.

Long Term Care Plan

Address the issue of long-term care. According to the PBS, a full 70 percent of all seniors will need some long-term care as they age. Even if your parent is healthy today odds are they will require long-term care and the costs are staggering. Some life insurance companies will add a long-term care rider to an existing policy. Medicaid also can cover some long-term care costs, but neither standard health insurance nor Medicare will cover your parent’s long-term care expenses.

Meet the Team

Ask your parent about their financial advisors and request a brief introduction to them.  Find out who they are and how you might contact them in the event your parent is unable to do so. This information will allow you to keep an eye on your parent’s accounts and be confident the advisors are trusted, objective, and well versed in elder financial issues. Oversight by you in a slightly detached way provides your parent privacy and independence about their finances but allows you to protect them from unscrupulous advisors. 

Understand Filing System

The last thing you need to discuss is where this vital information is filed so that before a crisis hits you know where to find the important documents, online passwords, and forms of ID you will need to facilitate your parents well being. While you do not have to see all the specific contents of the information, particularly the financials, knowing where they keep the data is critical in a crisis. Remember that as your parent ages they may start to change the location of the information. Check with them a couple of times a year to ensure the information is still in the same place and physically look to be sure it is.

Discussing your parent’s strategy is best begun while they are healthy.  Proactive planning is the best way to help your family as your parents age.  Contact our office today and schedule an appointment to discuss how we can help you and your family.

Elder Living

Options for Senior Living Depend on the Level of Care Needed

As we grow older, senior living options vary widely based on what level of care is required. Available options are tied to the resources a senior has to cover living costs, and vary widely in cost, assistance, and care provided. In addition to budget considerations, seniors must also realistically consider the needs they have and what senior living option best fits those needs.

Nursing Homes

Nursing homes, or skilled nursing facilities, are one option for senior living. These facilities are for seniors who can no longer live independently. They provide care for seniors with illnesses or mental conditions that cause them to require monitoring and medical care on a full-time basis. For example, many nursing home patients have dementia, are confined to a wheelchair, or spend most of their time in bed. Their conditions require that medical attention be available around the clock.

Nursing homes also provide the option for short-term care, where patients come and stay for a limited time after major medical events such as strokes or heart attacks. In these facilities, the residents generally live in semi-private rooms and all meals are provided. Medicare may help cover the cost of skilled nursing facilities, assuming the resident meets certain financial requirements. Long-term care insurance may also pay for nursing home care.  Otherwise, a nursing home resident pays privately, which can often bring financial hardship to the family. As a result, many families work with an elder law attorney to discuss care options as well as payment options for that care.

Assisted Living Facilities

Another option for senior living is assisted living facilities. These facilities are ideal for seniors who are still independent but may need some assistance with activities of daily living, as well as meals, cleaning, or other daily self-care tasks. These facilities usually offer a more private living conditions. Since residents may be fairly independent, assisted living facilities are an appealing option because they often offer a variety of activities and opportunities for seniors to interact with one another and to stay active. Assisted living facilities are generally paid for privately with a few exceptions, including long-term care insurance or partial assistance from Medicaid.

Independent Living Communities

An independent living community is another viable option for senior living. These communities are for independent, active seniors who enjoy the idea of living in a community. Independent living communities are much like living in a condo or as a part of a community with an HOA. Often maintenance, housekeeping, and landscaping are part of what is included with living in these retirement communities.  Many seniors choose this type of community when they are no longer able or no longer wish to maintain a home. The housing options for independent living communities range from detached homes to apartments. Another benefit of retirement communities is the wide range of amenities and activities available. Seniors are often lonely and living among other seniors can provide friendship and companionship. Residents in independent living communities pay privately, and the cost varies from one community to another.

Memory Care

Memory care facilities provide a more specialized senior living option for seniors who have serious cognitive impairments, such as Alzheimer’s or dementia. These facilities are much like assisted living facilities but cater to cognitive impairments. They may even be a specialized part of an existing assisted living facility. The staff at memory care facilities have specialized training that helps them better assist residents with cognitive impairments. They are often planned intuitively to help patients who may become easily disoriented. These facilities also give extra consideration to security for residents who may wander due to their cognitive impairment. If a senior needs this kind of care, it is important to plan and look for facilities that provide it ahead of time.

Senior living options vary greatly in care and cost. It is important that seniors have conversations with their families about the needs they have or may have in the future, as well as the cost of the type of care they wish to have. The earlier the planning begins, the better off the senior and the family will be when the time comes to seek alternative living options. This planning should be a part of the overall legal and financial plan of the senior.

If you have any questions about something you have read or would like additional information, please feel free to contact us. Please contact our Reno office by calling us at (775) 853-5700.

Elder Law, Elder Living

Important Considerations Before Turning 65

In order to make the most of your estate and government benefits, several factors need to be addressed before turning 65 years old. Overall, the most crucial thing to do before turning 65 is to invest your time wisely crafting the best approach possible for your health and financial security well-being. 

Can you afford to retire? Are you married? Estimate your total annual spending, including a cushion for periodic or unforeseen expenses like home repairs or dental work. Total all of your potential retirement-income sources and understand the tax implications associated with their spending. Run through several scenarios where you change what year you claim social security benefits to see if you should defer collecting it to a later age. Be realistic and start adhering to a modest budget today. Very few Americans can withdraw a lot from personal savings and investments without risking running out of money too soon. As you start to gather your assessments in general about how you view your retirement, find a qualified retirement planning expert that can help you with projections that are based on realistic assumptions.

Familiarize yourself with Medicare and its associated program variations. If you are retiring, you will approach Medicare differently than if you continue to work and have health care available through your employer. If you no longer will have health care through an employer, learn about Medigap supplemental insurance policies as Medicare will not cover all of your health care. Health insurance becomes quite complicated and varies widely depending on your overall health and personal financial situation. The National Council on Aging (NCOA), in partnership with private companies Aon Retiree Health Exchange™ and Via Benefits™, provides a checklist and timeline that can guide you through the process of enrolling in Medicare and assessing how you will cover the cost of prescription medication. If your income is low, you may qualify to enroll in Medicaid, which covers more expenses than Medicare. If you have already begun to take your social security benefits, then you will automatically be enrolled in Medicare. A packet entitled “Welcome to Medicare” will be sent to your address three months before turning 65. There are essential actions to take, and deadlines associated with this packet so read through the material carefully and meet those deadlines.

There are resources available to help you understand what your options are and the best way for you to proceed. As you approach the age of 65 many private insurance companies will lobby for your insurance dollars that will be spent on supplemental insurance. Finding a retirement planning company with insurance brokers that can sell you policies from many different insurance companies is more advantageous than locking into a group that will only sell plans that are associated with their company. A reputable insurance broker should not charge for helping you to assess your situation as they make commissions from the insurance company providing the policy to you. Check with the Better Business Bureau (BBB) online where you can plug in the name of an insurance group or retirement counselor and find out how long they have been in business, their accreditation, BBB rating, and customer reviews and complaints.

If you are over the age of 50, you can contribute an extra 1,000 dollars annually to your IRAs and an additional 6,000 dollars to 401(k)s up until the age of 65, according to Kiplinger. If you are still working, this is an excellent way to boost your retirement spending money. Before 65, you need to explore the option of a long-term care insurance policy, which helps to pay for any assisted living care needs you may require in the future. Long-term care policies can be expensive. If you do not enroll in a long-term care plan before the age of 65, the policies will become practically unaffordable.

Before turning 65, you should also come to terms with your will, advance medical directives, trusts, and the difficult conversation with your spouse or children about your end-of-life wishes and any funeral arrangements. Take heart, turning 65 is far from a death sentence as many Americans are living long and active lives well beyond the age of 65; however, meeting with an elder counsel attorney can save you and your heirs plenty of money and heartache. Do not wait until an adverse medical event forces your family or loved one to act on your behalf financially or medically. Decisions made under duress do not provide the best outcomes. Beyond your will, power of attorney, and power of medical attorney, consider a dementia directive as well. Projections for the aging US population indicate an ever-increasing number of seniors who have Alzheimer’s and other forms of dementia. Your elder counsel attorney can guide you through your options. Some states even have working templates for dementia directives. As you age, you can review your legal strategies from time to time and make adjustments as you deem necessary. It isn’t easy to discuss your end-of-life scenario, but once you have had the discussions and put proper legal documents into place, you can move forward with a sense of relief. It is freeing to make decisions and act on your future behalf, knowing you can always revisit your choices.

Now for the fun stuff, get excited about the senior discount. While it is true that there are discounts available as early as 55 and 62, nothing beats the senior discount at age 65. You can check off that bucket list of yours with deals on restaurant meals and travel excursions, clubs, retail stores, hotels, cinemas, smartphone plans, AARP membership discounts, and more. If you do not see an offering for a 65 senior discount posted, by all means, ask.

Beyond Medicare eligibility, you can get a one-time free physical exam if you have Medicare Part B insurance coverage. Gyms and community programs offer discounted or free physical fitness programs so that you can keep yourself moving and as healthy as possible. If you have Medicare, check out your eligibility for SilverSneakers for a 65+ fitness program. Your local senior center can keep you socially active and connected to people your age. Making friends and enjoying the simple act of conversation is known to have many benefits for your cognition and staves off isolation and depression issues.

If you retire from your job at 65, you can finally begin to collect on your pension plan or 401(k). That in itself is worth a celebration after many decades of hard work. You might also opt to collect your social security benefits, but it is generally advisable to wait until you reach full retirement age.

Homestead benefits and property tax exemptions are considerable benefits for those who already own or plan to own a home or property. Benefits vary by state, so you will need to see what you can qualify for where you live. Your local comptrollers’ office can provide information about offers regarding homestead benefits. For property tax exemptions, you must contact your local comptroller or tax assessor’s office for exemption information.

There is a lot to discover, learn, and know about how to proceed in life at age 65 and beyond. With Social Security benefit determinations, health insurance policies, and legal documents in order, you can begin to enjoy being 65. Start your education about being 65 or older today. Stay vibrant and healthy and enjoy those things you dreamed of doing when you were your younger self. 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.