Consumers and Loved Ones Frustrated with Lack of Transparency in Senior Housing

If you have done any research to identify the right place for your loved one to live as you grow older, you’ve probably been frustrated that although you can learn everything about the facility on the website, there is a lack of transparency with regard to pricing.ThinkstockPhotos-670054130
According to the Genworth Cost of Care study, most recently completed in 2016, a private room for a nursing home was above $92,000 in a median annual cost and the median annual cost for assisted living was just over $43,000.
A research director at a company consulting in the 50 plus market states that they have been researching since 2010 and have been unable to find clear pricing information for seniors looking for alternative living options. Advocates argue that clarity is extremely important for people to be able to make informed decisions about what is best for their loved ones so that they know whether or not the facilities fit in their budget and the true cost of care provided to their loved ones.
Consumer Reports argues that price and quality information should be transparent as one of the six protections that consumers need in the elderly housing market. According to the National Center for Assisted Living guiding principles, assisted living communities should be prepared to explain their policies regarding deposits, fees, and other costs associated with moving a loved one into the facility. The facilities responding to these calls for greater transparency believe that it is impossible to quote cost because the situation is different for every resident.
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Long-Term Care Rate Hikes Troubling

As members of the Baby Boom generation move into retirement and beyond, long-term care insurance policies to help cover the costs of assisted living or nursing homes are becoming more and more of a necessity, rather than a luxury.

Nursing home clown visit

(Photo credit: Kara Newhouse)

Unfortunately, the cost of these policies is rapidly become prohibitive for a large segment of our aging population, according to a recent story in the Richmond Times-Dispatch.
In the story, staff writer John Reid Blackwell notes that such policies date back nearly four decades and that millions of Americans have been paying the premiums for them.
“Yet costs for long-term care insurance have been rising dramatically in recent years, the result of numerous factors including miscalculations by the insurance companies that have sold policies,” according to the story. “Faced with higher-than-expected payouts on long-term care policies and lower-than-expected investment returns on premiums paid, some insurers have exited the market entirely.
“Other major providers such as Henrico County-based Genworth Financial Inc. and Boston-based John Hancock Financial, a division of Canadian insurance company Manulife Financial, have sought approval from state insurance regulators across the country to raise premium rates. The rising rates mean that people who may have been paying for a policy for many years are seeing double-digit percentage increases on premiums that can already run several thousand dollars a year.”
“This phenomenon in recent years of very significant premium rate increases for long-term care insurance is something that is pretty widespread in this country,” Jacqueline K. Cunningham, Virginia’s commissioner of insurance, is quoted as saying. “It is something that we have been keeping our eye on, and it is definitely a source of concern. We have gotten complaints from a lot of people who are concerned about the rate increases they have gotten.”
In Virginia alone, Blackwell noted, regulators have approved 82 rate increases sought by 33 legal entities for long-term care policies between Jan. 1, 2009, through Aug. 14, 2013, according to a study conducted for the State Corporation Commission’s Bureau of Insurance last year by members of the American Academy of Actuaries.
“The average annual premium increase was 36 percent, with a range of increases from 8 percent to 100 percent. As of Dec. 31, 2012, there were 259,159 individuals in Virginia covered by long-term care insurance policies, according to the report.
“A number of these policyholders have received financially challenging rate increases on their policies,” the report said.
“As a result, ‘some policyholders are not able to afford their current LTCI premiums and are having to reduce their policy benefits, if able to do so, or allow their coverage to lapse,’ the report said.”

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Reducing the Pain When Longtime Partners Must be Separated

Many people assume that for elderly couples the death of a spouse is an inevitable and heart-wrenching experience, and they would be correct.

Elderly couple, Paris

(Photo credit: i.tokaris)

However, separation from one another because one of the partners requires a greater level care than the other is almost as keenly painful.
“Sadly, this scenario is more common than one might think,” Dave Singleton wrote in a recent piece on the website Caring.com. “After decades of living together, one parent needs more care than the other can provide. It’s not only hard on the parents; it’s a devastating situation for children and loved ones, too. You want to help, but you feel helpless in the face of what amounts to a forced separation.”
Based on conversations with two experts in the field of eldercare, Singleton offered some tips on ways to reduce the trauma of such a separation.
They include:

  • Determine in advance how the relationship will continue.

“Before anyone makes a move, encourage your parents to map out how the marital bond will carry on,” Mary Koffend, president of Accountable Aging Care Management, was quoted as saying.

  • Ensure that the facility supports the couple.

“The key is to promote the couple’s identity as a couple as much as possible, or desirable, for both partners,” Cheryl Woodson, author of ‘To Survive Caregiving: A Daughter’s Experience, A Doctor’s Advice,’ told Singleton. “Make sure the facility is convenient for the healthy partner in terms of transportation, access, and schedule.”

  • Help your parent with feelings of guilt and inadequacy.

“A parent might feel like he’s no longer honoring his wedding vows, or that he isn’t doing enough,” Koffend said.

  • Get your parents outside help if needed.

“No matter how cooperative the facility is, no one can understand how bereft these couples may feel,” Woodson was quoted as saying. “Families should encourage the healthy partner to talk to clergy, behavioral health professionals, and/or to participate in support groups with other spouses in similar circumstances.”

  • Help foster private time, if desired.

“For example, if a spouse can’t leave the facility for whatever reason, kids can step in and have a very straightforward conversation with the facility’s administrators about arranging alone-time for the couple,” Koffend told the Caring.com writer.

  • Expect the unexpected.

“Don’t assume that this transition ends once the initial decision and move are over,” Koffend advised. “Be prepared for whatever your parents’ needs are afterward, when there’s sadness or frustration on either side. Help your parent realize they have a practical role in the care and upkeep of their spouse who’s now living in a new place.
“It gives purpose to the visits, even if it’s as simple as bringing a few products and a hairbrush to help maintain physical appearance.”

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Once Care Facility Is Decided Upon, Questions Must Continue

Finding the right care facility for an elderly loved one, whether it’s a mother, father, aunt, uncle or some other person held dear, is a lot of work.

That work doesn’t end once the search is completed, as noted in a recent article in U.S. News and World Report. The questions that needed to be asked to find the facility must be followed up with ongoing questions once care is started, the article indicates.
“The resident’s needs should be met by the facility, rather than having the patient meet the facility’s needs,” Barbara Messinger-Rapport, director of the Cleveland Clinic‘s Center for Geriatric Medicine, told the magazine.
“Ask the questions you would want to be asked if the roles were reversed,” Cornelia Poer, a social worker in the Geriatric Evaluation and Treatment Clinic at Duke University Medical Center in Durham, N.C., was quoted as saying.
She said that these questions should include:

  • Are you comfortable?
  • Is anything worrying you?
  • Do you feel safe?
  • Do you feel respected?
  • If you need help and you push the call button, how long before somebody comes?
  • Have you gotten to know any of the other residents?
  • Do you like the staff, and any staff member in particular?

“Show interest and concern and identify major problems, but don’t go overboard,” the article advised.”
Inquiries are important, but try to avoid turning every visit into an interrogation,” Poer said. “You will be able to determine if there are areas of concern in normal, everyday conversation.”

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What to Consider When Choosing a Long-Term Care Living Situation for your Loved One

Choosing a long-term care living arrangement is one of the most difficult challenges faced by aging adults and their loved ones. Most families try to avoid the nursing home option to the very end, believing that assisted living or small residential care homes provide a better quality of life. But this may not necessarily be the case.

New research suggests that the type of living situation itself makes little difference in a resident’s emotional well-being. Instead, the happiness and contentment of the resident depends more on the characteristics of the specific environment they’re in, and of course in no small part on their own personal characteristics — how healthy they feel they are, their age, and even their marital status.

Logically enough, a resident of a long-term care facility of any kind is more likely to report satisfaction and comfort if they had a hand in choosing their living situation, if they were part of the decision making process. In fact, studies show that the process of finding and choosing a living situation—researching options, visiting facilities, considering current and future social and physical needs and how they will be met—plays a very important role in the beginning of acclimatization.

Whatever your choice, you’ll need to talk to your family and plan how to finance whichever choice is made for long-term care living. Medicare.gov has published a helpful chart summarizing and comparing the various options for long-term care financing. Or please feel free to contact our office for more information.

How to Prepare to Care for Aging Parents

If you are the child of parents who are currently over the age of 65 you’ve probably given a little bit of thought to the day when one (or both) of your parents may need Long Term Care. Understandably, most adult children prefer not to think about the day when their parents may not be able to care for themselves, but in some cases it simply cannot be avoided, especially if your parent is already showing early signs of Alzheimer’s or dementia. If you are concerned about your parent’s future, there are steps you can take now to make the transition to giving and receiving care later easier on both you and your parents:

1. Talk to your parents. Find out if your parents have already thought about the topic, if they’ve made provisions for it, or if they have any specific wishes. Furthermore, opening the lines of communication lays the groundwork for trust and cooperation in the future.

2. Encourage your parents to create an Estate Plan if they don’t have one already. An Estate Plan will be important in expressing your parents’ wishes on necessary issues such as preferred agents in case of incapacity, financial power of attorney, and health care decisions. These essential documents will not only let you and others know their wishes, it will also prevent many expensive delays and frustrating red tape in the future.

3. Talk to trusted advisors about how to prepare for the financial burden of Long Term Care—because there will be a financial burden. Our firm can help you your options with Medicaid and Long Term Care Insurance, as well as some lesser known options such as a Dependent Care Account.

As you think and talk about these issues with your parents, siblings, and other trusted advisors, remember that you don’t have to go through this alone. Elder Law and Long Term Care are intricate and convoluted subjects, but there are caring professionals out there whose business it is to guide you through the intricacies of Elder Care. Let us help you look into the future with confidence and clear eyes.

Finding A Trustworthy In-Home Caregiver May Not Be As Easy As It Sounds

As American seniors age and find that they need more and more help with daily tasks, many of our parents and grandparents are choosing NOT to go into nursing or retirement homes, opting instead to age at home with the help of in-home care. Of course, deciding that you want to age at home is one thing, but finding the right in-home aide—and figuring out how to pay for that aide—is easier said than done.

Hiring a home health-aide means bringing a stranger into your home during a vulnerable time; and according to this recent article published on the Northwestern University website, not all aides or agencies are created equal. “A troubling new national study finds many agencies recruit random strangers off Craigslist and place them in the homes of vulnerable elderly people with dementia, don’t do national criminal background checks or drug testing, lie about testing the qualifications of caregivers and don’t require any experience or provide real training.”

While it’s true that finding a trustworthy and experienced aide may be difficult, the good news is that there are plenty of excellent caregivers out there, and simply knowing the right questions to ask can make your search a whole lot easier. The article mentioned above lists 10 questions to ask an agency before hiring a caregiver, including questions such as:

* How do you recruit caregivers, and what are your hiring requirements?

* What types of screenings are performed on caregivers before you hire them? Criminal background check—federal or state? Drug screening? Other?

* Are the caregivers insured and bonded through your agency?

* If there is dissatisfaction with a particular caregiver, will a substitute be provided?

* Does the agency provide a supervisor to evaluate the quality of home care on a regular basis? How frequently?

Hiring a caregiver or aide to come into your home can be fraught with stress and second-guessing, but knowing that you don’t have to go through it alone—that there are trustworthy friends, agencies and advisors who can help you—can not only make the process a whole lot easier, but can also make you and your entire family feel much more comfortable with the person you eventually choose to hire.

Making the Transition to a Long-Term Care Facility as Smooth as Possible

One question that we often get from our clients is how to know when to place a parent into an assisted living facility or nursing home. Making this decision can be difficult, and disagreements about the best options can cause tension and confusion within the family. However, if you plan ahead and know the physical and mental signs to look out for, knowing when it is time to make the transition can be a much less heartbreaking experience. Below are some of the most important steps that you can take to ensure that you know when to help your parent make the permanent move to an assisted living facility or nursing home – and what to do once the decision has been made.
1. Initiate the discussion before a move becomes necessary.
Moving to a nursing facility is hardly a pleasant thought, but for many seniors it will become a reality. Many children of our clients experience guilt or concern that they may not be acting consistently with their parent’s wishes when they make arrangements for them to move into a long-term care facility. However, if you begin discussing options with your parents while they are still healthy and able to express their wishes, you can eliminate much of this guilt and insecurity. Talk to your parents about what type of facility they expect to move into, what aspects of long-term care are most important to them, and even which specific facilities are the most attractive to them. Initiating the conversation before the situation reaches a crisis point will help you (and your parent) to be capable of making the correct decisions when the time comes to make the move.
2. Be on the lookout for changes in physical capabilities.
People who move to long-term care facilities often do so because they are physically unable to care for themselves. While some people need extensive care, those who move to assisted living facilities may only need help with one or two activities of daily living. If the layout of your parent’s house has made it difficult or dangerous for them to move around easily in the home (for example, they can no longer climb stairs), living in the home may no longer be an ideal situation. It is important to look for evidence that your parent has fallen or stumbled. A typical warning sign that someone needs to move to a long-term care facility is when they have experienced several falls without being able to get up or call for help. Assisted living and nursing facilities have round-the-clock staff on hand to monitor residents.
Another warning sign is when the house begins to appear dirty. Perhaps Mom’s house was always spotless, but lately you’ve been noticing crumbs in the kitchen and dirt on the floor. These could be signs that your parent is no longer able to care for her home in the way that she would like, and it may be time to consider moving her to an assisted living facility.
Further physical signs that it may be time to consider speaking with your parent about moving outside of the home include evidence of frequent sleep disturbances, difficulty dressing or bathing, and difficulty preparing meals.
3. Be on the lookout for changes in mental capabilities.
Has your parent exhibited sudden changes is personality? Is it becoming obvious that she is forgetful or frequently disoriented? Are you concerned that your parent has begun to make poor decisions or has had difficulty making decisions at all? Each of these issues could mean that your parent has dementia. Because diseases causing dementia are usually progressive, their condition usually will not improve and it is important that your parent move into an assisted living facility or nursing home before the dementia worsens. Symptoms such as forgetting to take medication, difficulty operating electronics like the telephone or the stove, and dangerous driving habits can also be signs that it’s time to consider moving to a long-term care facility.
4. Schedule a family meeting.
Once you’ve determined that your parent’s physical and mental symptoms show a need to move out of the home, it’s important that you schedule a family meeting. This allows everyone in the family to share their concerns and to make decisions together about who will be involved in the decisionmaking process and how to proceed with the move. Remember to include your parent’s caregivers in the family meeting – their input can be important in determining what your parent’s needs are.
At the meeting, it is important to have an agenda to help everyone focus on what decisions need to be made. This agenda could include discussions about your parent’s medical status, sharing feelings and opinions about the situation, financial concerns, and how to move forward. If you feel that there may be disagreements between family members, you may want to hold the meeting in a neutral place and have a disinterested third party mediate the meeting.
5. Research long-term care facilities in the area.
If you haven’t already done so, now is the time to research different options for long-term care in the area where your parent will be living. One option is to go to www.snapforseniors.com to research different facilities in your area. Once you find a facility you’re interested in, you can call the facility to take a tour, check references from families of former or current residents, and weigh your financial options.
6. Continue to keep family involved.
Moving to a long-term care facility is a large transition for everyone, not just your parent. It is important that you keep your family informed about what decisions have been made, even if they are not directly involved in the decisionmaking process. If some family members are contributing more time or money to the transition process than others, it is important to acknowledge this effort and attempt to achieve balance within the family if possible.
7. Most importantly, continue to keep your parent involved.
Of course, the person for whom the transition will be the most difficult is your parent. She may be feeling confused or angry at the thought of leaving a home that she may have lived in for a number of years, or she may not understand where she is once she lives in her new home. This is especially true if your parent suffers from dementia. It is important that you allow your parent to express her feelings about her new home and that you listen to her concerns. One way to ease her mind could be to ask her how she feels about the new location at a time when she is calm and there are few distractions. Depending on the situation, it may be helpful to visit the facility with your parent shortly before the move so that she can learn more about it and start to become comfortable there.

How to Make a Smooth Transition into Assisted Living

For many seniors, moving into an assisted living facility can be a difficult and confusing transition. Many elderly people become confused or agitated during or after the move. The Aging Parents Authority recommends taking the following four steps to make the transition as smooth as possible for your parent.
1.   If your parent suffers from dementia, don’t over-explain the move.
Acting in a way that is as matter-of-fact as possible helps your parent feel that the move is more of a natural change. Don’t worry your parent with unnecessary details or questions about the move if you feel that they will be unable to absorb too much information at once. However, it is important not to be dishonest with your parent – after all, they are the one making the move. Give your parent all of the facts in small doses rather than all at once.
2.   Bring in other family members to help.
Having several family members involved allows everyone to take part in the move. This is important because it prevents other family members from having their feelings hurt while keeping you from becoming overwhelmed with the task of helping your parent make the move.
3.   Keep your parent away on the day of the move.
Having your parent present while her things are being moved out of the home she may have lived in for decades can be traumatizing for her and delay the moving process. After you have made all of the arrangements and it is time to make the move, arrange for professional movers to come in and move her belongings. Meanwhile, take your parent out to lunch or somewhere special to make moving day as pleasant and relaxing as possible.
4. Give your parent a chance to try out the assisted living facility.
Many elderly people have a difficult time adjusting to their new environment at first. However, most of the time your parent will become used to the routine of the assisted living facility and will even make friends and enjoy the activities offered there. However, nothing should be written in concrete until you are sure that your parent can live comfortably in her new surroundings. Make sure that the contract you sign with the facility allows your parent to go through an adjustment period before you are required to make a long-term commitment.