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.

Elder Living

Living Alone in Your 50s and 60s Increases Your Risk of Dementia

Living arrangements for aging Americans are decidedly leaning towards aging in place. Nearly all older adults prefer to age in the comfort of their long time homes and familiar community surroundings. Aging in place often means living alone. Pew Research findings show that older people are more likely to live alone in the United States than in any other country worldwide. This preference of living solo, however, comes with hidden danger. Research from Science Times reports that living alone in your fifties and sixties increases the likelihood of dementia by thirty percent.

The conclusion drawn is based on a report from sciencedirect.com, a website replete with large databases of scientific, academic, and medical research. Findings indicate that social isolation is a more important risk factor for dementia than previously identified. In this age of gray divorce (also grey divorce) and social distancing due to the coronavirus pandemic, adults living alone in their fifties, sixties and beyond, are at greater risk than ever for cognitive decline, leading to dementia.

Understanding the Causes of Dementia Cases

The lead author of the study, Dr. Roopal Desai, says that overall increases in dementia cases worldwide can be due to loneliness, stress, and the lack of cognitive stimulation that living alone brings. Biologically, cognitive stimulation is necessary to maintain neural connections, which in turn healthily keep a brain functioning. Staying socially interactive is as important to cognitive health as staying physically and mentally active.

Strategies for Seniors Living Alone

Health care professionals in the U.S. are implementing a “social prescribing” strategy to improve the connection of a patient who lives alone to a prescribed range of services like community groups, personal training, art classes, counseling, and more. Unfortunately, in the days of COVID-19 social prescribing is limited to virtual connections between people. However, virtual social engagement is better than no social engagement at all.

Why can’t an adult, choosing to age alone, maintain their health with physical exercise, crossword puzzles, and other activities that stimulate their brains without the input of human socialization? It turns out that social isolation presents a greater risk for dementia than physical inactivity, diabetes, hypertension, and obesity. Brain stimulation is vastly different when a person engages in a conversation rather than in repetitive games and puzzles. Carrying on a conversation, whether in person or virtually, is far more stimulating and challenging to the brain’s regions.

Conversation with other people chemically evokes neurotransmitters and hormones, which translates into increased feelings of happiness and reduced stress through purpose, belonging, improved self-worth, and confidence. It turns out that being human is undeniably an experience at its most healthy when shared, and a mentally healthy person is prone to stay more cognitively capable.

The Importance of Human Connection to Decrease Dementia

Maintaining this human connection can be challenging, particularly if you are one of the many Americans who are opting to age in place. In the first place, aging is replete with reasons to reduce activity and become isolated when facing particular types of stressful events common to later life years. Role changes associated with spousal bereavement through death or divorce, household management, social planning, driving, and flexibility all fall prey to functional and cognitive limitations. Without the benefit of an involved family or social prescription, it is easy for an aging adult to spiral into social isolation, loneliness, and depression, all of which are causally linked to cognitive decline.

If you or your aging loved one actively chooses to live alone, it is imperative to maintain a vibrant social life. Staying cognitively healthy is associated to satisfying social engagement as well as physical activity. If you live alone, reducing the risk of developing dementia will allow you to continue living out your years as imagined, with independence and control, thanks to your continued human interactions.

If you have concerns about your current living arrangements (or those of a loved one who needs care), please reach out. We help families create comprehensive legal plans that cover care and financial concerns. Please contact our Reno office by calling us at (775) 853-5700. We’d be honored to speak with you.

Elder Law, Elder Living, Estate Planning, Healthcare

Will the Cost of Long-Term Care lead to the Loss of My Home?

People work hard all their lives to own a home, and it is often their most valuable and significant possession. Homeownership is the American Dream. So, when health begins to fail and the need for long-term care arises, we often get this fear-filled question from our clients: will they take away my home?

The enormous and on-going costs of nursing-home care are astronomical, on average around $8,500.00 a month depending on location. The joint federal and state Medicaid program foots the bill for one in four of around 75 million recipients in this country. This is an enormous drain on government funds. To recoup some of those costs, then, the Medicaid rules permit states to take the value of a recipient’s home in some cases, to reimburse the program for funds it has expended.

Yet, because a home is such an essential family possession, the rules treat a primary residence as exempt – that is, its value is not counted as available to pay for nursing-home care from the home-owner’s pocket, before Medicaid kicks in. The home is protected, to a certain extent, for the benefit of Medicaid recipients and their close relatives.

That protection can be lost, however. The value of the house can be counted against a Medicaid applicant, and benefits denied or curtailed, when:

*     A home-owner has no living spouse or dependents, and

*     The owner moves into a facility permanently, with no intent to return home, or

*     The owner dies.

In other words, as long as the owner expresses the intent to return home, and the owner’s spouse or disabled or blind child live in the home, the home will not be counted against the owner for Medicaid-eligibility purposes.

Once the owner passes, however the state may place a lien on the home, to secure reimbursement of the value of the Medicaid services the owner received. This lien makes it impossible to sell the home or refinance a mortgage, without first paying the state what it may be owed.

As elder law attorneys we know a number of ways to protect homes from this kind of attachment. If you come to us at least five years before you anticipate needing nursing-home care, we can preserve your home or its value such that Medicaid will not count it, or lien against it, at all.

Or, if a child moves into the home and cares for an ailing parent for two years, permitting the parent to stay home and out of a nursing home, the house can then be given as a gift to that child without any Medicaid penalty or disqualification. Ordinarily, Medicaid heavily penalizes giving away property, but this is one exception.

There are other strategies available. The home can be given to a disabled child without penalty or disqualification. Or, you might keep the right to live in the house for your lifetime and deed the remainder interest to others, who will then own the house after you pass. However, each strategy comes with risks that must be fully explored before determining the correct one.

An overall plan that is tailored to suit each individual, and to meet as many contingencies as possible, requires juggling a number of puzzle-pieces. There is no one cookie-cutter solution. The key is to plan before you or your spouse may need nursing-home care.

As one piece in the overall picture of a balanced estate plan, we can help you save your home. We welcome the opportunity to work with you, please contact our Reno office by calling us at (775) 853-5700.

Elder Living

Alternative Views on Facility Living with Alzheimer’s Patients

As the aging population rises, Alzheimer’s Disease is also on the rise for elderly moving into nursing home facilities. The National Institute of Health (NIH) Library of Medicine reports the most common form of dementia is Alzheimer’s disease, accounting for approximately two-thirds of all diagnosed cases of dementia. Alzheimer’s is also one of the most expensive diseases to treat and often results in financial strain on families trying to find and pay for the best care. In the past, care in facilities often resulted in Alzheimer’s patients being separated from others. However, as you’ll read below, facilities are now exploring better ways to treat Alzheimer’s patients while living in a facility.

Medical breakthroughs that increase our understanding of how to best treat and introduce disease modification therapies for people living with Alzheimer’s and other neurodegenerative diseases provides future hope. However, according to the Alzheimer’s Association, there are already more than 5.8 million Americans living with Alzheimer’s disease. These individuals may not live long enough to benefit from new therapy discoveries since new treatments must undergo rigorous testing and clinical trial phases. Current projections indicate that unless some of these medical breakthroughs have practical applications very soon, more than 14 million Americans will be clinically diagnosed to be living with Alzheimer’s by 2050, with many more struggling in the long-preclinical phase of the disease.

As senior living facilities become more saturated with dementia patients in all stages of progression, there is a shift underway towards non-segregated memory care living. Alzheimer’s patient reintegration into general senior living residence status is shifting dementia care into a human-centric model. It provides insights and lessons into eldercare facility living, its providers and staff, family members of residents, and all of the patients, not just memory care patients. This human-based approach is a kinder, more medically practical and appropriate, and in the long term, a more cost-effective method for facility residents who have dementia.

Before there were outcome-based clinical research findings to support the segregating of dementia patients care facilities began creating stand-alone memory care units, floors, and facilities.  Families knew their loved ones were safely locked away in a highly monitored unit, and staff could focus their training and efforts in a more specified range of care. Because this isolation model became overwhelmingly profitable for business operators, it became the de facto standard of memory care operation. Profits were trumping the human condition. At the outset, it seemed rational enough to put like-patients together, yet because everyone’s memory disease progression is unique, the concept was flawed. Living circumstances for humans is an emotional experience, and the sad outcome for assembled memory care patients was faster disease progression in their isolated, shrinking worlds. This accelerated mental decline was partially due to the lack of broader social and emotional connection with non-dementia residents. It seems integrating patients of all types and generations enriches and expands what residents can do, creating a diverse human model focusing on the positive aspects of life and personal interaction.

Some of the conditions all aging adults share, not just those living with dementia, include difficulty hearing and seeing, finding mental focus more demanding, becoming more concerned about being in large crowds, and noises that increase their stress levels. For a community of residents, no matter what the patient illness, facilities can create an atmosphere that addresses these common concerns. These shared needs include not only medical care but activities that are available in a 24-hour cycle and the encouragement of socialization in smaller, quieter circles. Interactions among residents in this calming style of environment tend to create friendships organically and provide enriching connections among patients irrespective of their illness type. The overall common conditions of aging require sameness in approach, no matter how varied the residents’ medical conditions are.

Technology that allows for digital wrist monitoring of patient location and vital signs permits ease of monitoring residents, particularly as they wander their living space.  Even the proper lighting, carpeting, and circular hallway architecture reassure residents’ feelings of safety, comfort, and familiarity, which appeals to all, regardless of diagnosis. When an entire senior living facility is dementia friendly, and all staff is trained in memory illness and care, every employee can add value to a resident’s enjoyment of life from the medical professionals to the social workers to the landscapers.

A diagnosis of Alzheimer’s can strike fear and worry in America’s aging population because of the emotional, physical, and financial upheaval associated with it. An older person might recognize the onset of some memory problems and become terrified, thinking about Alzheimer’s and the possibility of being relocated from their home and community to a dementia unit. There is a sense of dread that you may never feel seen, heard, and loved again by other people. Interpersonal relationships and connectedness are a hallmark of the aging communities in America. AARP reports large percentages of technology use in older Americans is related to interpersonal connections like email, viewing photos of family and friends, and using social media and the internet. Even in digital spaces and experiences, elderly community residents are looking to create personal networks, connecting to the world at large. The human spirit inclines to be expansive.

Appropriate social and physical environments play a significant role in healthy aging. Compartmentalizing memory care patients into homogeneous units will increase their memory decline, isolate their human connection, and spiral the patient into an ever-shrinking world of interaction, often making them non-verbal. Alzheimer’s patients who experience higher levels of social integration respond conversely, expanding their horizons as they experience and feel the extension of human love and support. There is no one set of symptoms for Alzheimer’s patients, and all patients are on their own trajectory of the disease. Mistakenly putting them together in a one size fits all approach of care has been a disservice to their health and well being and to the future care of others who will become afflicted with Alzheimer’s. The memory care model is shifting for the better and not a moment too soon.

We help families who have a loved one with dementia. We explore possible sources to help pay for care, like Medicaid, and we make sure our client’s wishes are stated in properly drafted legal documents. If you have a loved one with dementia, give us a call and let’s work on a plan to ensure your loved one has the best care possible, and their home and savings are protected. If you have questions, please do not hesitate to contact our Reno office by calling us at (775) 853-5700.

Elder Law, Elder Living, Healthcare

Lawmakers Discuss the Future of Healthcare

In June, Washington, D.C. political publication, The Hill hosted a Future of Healthcare Summit to address critical issues in healthcare, from the Medicare for All proposals made by Democratic presidential hopefuls to the opioid crisis. Speakers included policymakers, health officials, and industry leaders, on both sides of the aisle.

Sen. Joe Manchin (D-W.Va.), for example, took a critical stance on the idea of Medicare for All at the summit. His statements are summarized here. His concerns are practical; “We can’t even pay for Medicare for some,” he said, referring to an earlier report that Medicare will exceed its hospital insurance fund by 2026. Manchin, accordingly, prefers to fix the Affordable Care Act rather than create an entirely new system.

Another issue discussed at the summit was that of data security. As health care becomes increasingly digitized, the risk to people’s privacy rises, as evidenced by recent data breaches. Lawmakers are responding to these breaches, Sen. Mark Warner (D-Va.) by reaching out to health care groups for input on strategies to improve cybersecurity, and Sens. Amy Klobuchar (D-Minn.) and Lisa Murkowski (R-Alaska) by introducing the Protecting Personal Health Data Act. Read more about this here.

High-cost drugs are another upcoming issue in the health care world, discussed in this The Hill article. Innovative cures may merit a high price, but some companies are asking such massive sums for potentially life-saving solutions that they are inaccessible to the people who need them. Accordingly, lawmakers are trying to come up with solutions to make these drugs more affordable, such as Sen. Chuck Grassley (R-Iowa), who has considered allowing Medicaid to pay for drugs over time.

In the same vein, Rep. Tom Reed (R-NY.) called for the cost of insulin to be lowered in an op-ed in The Hill, available here; he notes that insulin prices have doubled in the last seven years, and tripled in the decade prior, that out-of-pocket insulin costs can exceed $300 a vial, and that patients are often racking up debt or skipping doses with serious health consequences. Reed is pushing for transparency from insulin manufacturers and has introduced the SPIKE Act, which would require justification for price hikes. Likewise, Rep. Buddy Carter (R-Ga.) has expressed his concern in a recent op-ed about the prices for drugs which treat cancer and is also pushing for transparency to lower costs.

Meanwhile, Reps. David Trone (D-Md.) and Donald Norcross (D-N.J.) wrote into The Hill, responding to issues of addiction raised at the conference. Trone drew attention back to the opioid crisis and its ongoing effects and described the steps being taken to combat it. Norcross called for enforcement of the 2008 requirement that insurance cover mental health and substance-use disorders to the same extent physical ailments are covered, and for continued funding and new strategies to deal with substance abuse.

Finally, Sen. Tammy Baldwin (D-Wis.) criticized the Trump administration as “sabotaging our health system” by destabilizing the health care market and creating difficulties in accessing it. She cites specific efforts the administration has made to reduce access, including supporting attempts to overturn the Affordable Care Act. Baldwin has responded by supporting the ENROLL Act to restore funding for the Navigator, which had previously been reduced by the Trump administration and by introducing the No Junk Plans Act to reel back the administration’s expansion of junk insurance plans.

From data security to drug prices, The Hill’s Future of Healthcare Summit covered a lot of ground. These issues in health care and the responses proposed to solve them continue to develop.

The Schulze Law Group can help you or a loved one create a thorough medical plan for the later years in your life. If you live in the Reno, Nevada area, and you have any questions, please give us a call at (775) 853-5700, or click here to message us through our website.