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.
The right professionals can help you navigate the typical challenges faced by someone planning their estate- schedule a meeting today.

Nursing Homes Versus In-Home Care

Geriatric facilities in general are moving away from providing long term care beds and are instead increasing the number of rehabilitative beds offered.ThinkstockPhotos-547537462
This is largely due to financial reasons since Medicare will pay up to $600 per day for rehabilitative bed whereas Medicaid will only pay approximately $125 per day for a long-term care bed. This means there is decreasing availability of long term care beds and seniors will find it increasingly challenging to find places in high quality facilities. This is why increasingly home services are becoming an option.
A senior can initiate this process on their own or family members may sit down and discuss the benefits of having an elderly loved one receive aging at home care. In-home healthcare can provide a sense of familiarity and clear structure for a loved who needs additional assistance. Home care options can frequently be much less expensive than placement in a permanent facility, given that according to the U.S. Department of Health and Human Services, home care options cost around $6500 per month.
This allows for an increased mental health status, better feelings of dignity, and decreased healing time when a person is able to stay in their own home. Furthermore, family members may still continue to provide caretaking assistance while also knowing that they have a professional who is on hand to help as necessary. To learn more about the aging in place process, discuss this with your experienced estate planning lawyer.

Power Of Attorney Valuable, But Subject To Abuse

Most people turn to family, friends or even neighbors when they feel a need to grant powers of attorney to someone to act on their behalf.

That can, sadly, be a serious mistake, accord to a report on the website
“Statistics on power of attorney abuse are hard to come by, but experts recognize it as a prevalent problem,” according to the article
“Some kinds of power of attorney grant their holders far-reaching authority over the affairs of people who are physically or mentally unable to conduct their own business.”
The article cites a November 2013 report on elder financial exploitation from the Government Accountability Office that “listed power of attorney agents as one category of potential abuser whose actions can be particularly challenging to prevent.”
“Indeed, family members, friends and neighbors are the culprits in 34 percent of elder financial abuse cases, according to a study by MetLife,” the report continues. “Yet much of the education on senior financial exploitation centers on scams perpetrated by strangers.”
“We’ve got them so scared of answering the phone or going online, when the majority of the assets are going out the back door by a trusted niece,” the report quotes Randy Thomas, a former police officer in Columbia, S.C.
The vehicle that often enables this, the retired cop told, is power of attorney.
“Here’s what that can look like: A friendly neighbor offers to go pick up an elderly couple’s license plates. He has them sign a specific power of attorney for that sole purpose, printed from an automobile-club website. He takes that to the bank and uses it to withdraw money from the couple’s account. That’s an actual scenario that came before Thomas A. Swift, probate judge in Trumbull County, Ohio; the bank returned the money, because the teller should have but failed to notice the limited nature of the power of attorney.)
“Pamela Glasner, a filmmaker who lives in central Connecticut, experienced a more devastating scenario when a man from her parents’ Florida synagogue gained the couple’s confidence a few years ago. Glasner’s father, who had Alzheimer’s disease, had moved into a nursing home, and her mother lived alone and visited him daily. The man, who represented himself to nursing-home staff as the couple’s son, had Glasner’s father sign a power of attorney form that he then used to access their money and transfer their house into his name. The fraudster also had Glasner’s mother rewrite her will, naming him a beneficiary.”
“By the time we found out about it,” Glasner was quoted as saying, “all of our accounts were zeroed out.”
“When used properly, the power of attorney can assure that a trusted person is handling your financial affairs, or making health-care decisions for you, when you’re not mentally or physically capable of doing this yourself. Many lawyers include powers of attorney as part of a standard estate plan. Some recommend separate documents for financial affairs and health-care, while others create one document to address both.”

Improvements On The Way For Nursing Home Rating System

The Obama administration recently announced efforts to improve the quality of care in the nation’s nursing homes and strengthen the reporting system by which consumers obtain information about them.
Through executives actions and the president signing into law the bipartisan Improving Medicare Post Acute Care Transformation Act of 2014, the administration is seeking to strengthen Medicare’s widely-used Five Star Quality Rating System for Nursing Homes, also known as Nursing Home Compare, and streamline quality measures for nursing homes, home health agencies, and other post-acute care providers participating in Medicare.
“The Five Star Quality Rating System offers the most comprehensive overview of nursing home quality in the U.S., in an easy to understand format, based on data from onsite inspections conducted by trained, objective surveyors from state public health departments and (Centers for Medicare and Medicaid Services); quality measures submitted by the nursing homes is used to calculate certain quality measures, such as the prevalence of pressure ulcers, use of restraints, and the extent of injurious falls; and information about the staffing levels in nursing homes,” according to the announcement from the White House Press Office. “While the onsite inspections form the core of the rating system, CMS has been concerned that the quality measures and information about staffing levels rely on self-reported data from nursing homes that have been difficult to verify.”
Among other things, the Improving Medicare Post Acute Care Transformation Act, which takes effect in January, will require that staffing levels being reported by nursing homes can be verified through payroll records, the White House announcement stated.
In addition, the law will revise the scoring methodology for calculating a facility’s rating under the Five Star Quality Rating System.
“The Act will facilitate patients comparing outcomes across different care settings, supporting better choices and better outcomes for patients,” according to the Press Office. In addition, the IMPACT Act funds a key improvement to nursing home oversight, the collection of staffing data. Nursing and other staffing levels are closely correlated with quality in nursing homes and current data collection efforts have produced data of uneven reliability. The IMPACT Act also institutes more routine surveys of hospice providers, ensuring program standards are met for the benefit and safety of patients.”

Three-Step Process Can Help In Quick Long-Term Care Cases

An old saying goes, “Act in haste, repent at leisure.”

Dad at Diamond Ridge Healthcare Center (Novemb...

(Photo credit: cseeman)

Haste, though, can be obligatory when it comes to making decisions about long-term care for an elderly relative.
“Sometimes unexpected circumstances, distance or a lack of resources can escalate a situation to one of immediate need or crisis proportions,” according to a recent article on the website “A hospital may catch you off guard with plans of a discharge. Regardless of cause, you’ve got to find a care solution fast. Personal obligations or out-of-town coordination further complicate the situation.
“Fortunately, there are always care options available, even when time isn’t.”
The article offers a three-step process for arriving at a solution, one that should permit haste without regret.
These steps include:
“Ask family and friends to recommend caregivers or centers. Find and compare skilled nursing care centers online with Medicare’s ‘Nursing Care Compare,’ a rating site for Medicare- and Medicaid-certified nursing homes, professionally called skilled nursing care centers. Medicare has developed a five-star quality rating system based on health inspection results, care center staff data, quality measures, and fire safety inspection results. Though there is plentiful information you can find, relying on ratings alone is not sufficient enough to make a decision.”
“Based on your research, choose about three centers to visit. Call each to schedule a tour. Communicate the immediacy of your situation and ask to speak with an admissions director. The admissions director will tell you more about the center and availability. Only visit centers that you know have available accommodations.”
“After visiting nursing homes, professionally known as skilled nursing care centers, select the center that best meets your care needs.”

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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Less Costly Options Exist To Afford In-Home Care

While in-home care for elderly parents or other relatives may be a kinder approach than placing them in a nursing facility, it can also be a very pricy proposition.

English: My parents.

(Photo credit: Wikipedia)

A recent article offers some creative approaches to affording this option.
“In general, pay rates in urban areas are higher than in rural communities, and still higher on the east and west coasts than in the central United States,” according to the article. “Costs also depend on whether you’re looking for homemaker services, defined as ‘hands-off’ care, such as cooking, cleaning, running errands, and general companionship, or home health aide services, which include personal care, such as bathing and dressing. A comprehensive 50-state survey of care costs by MetLife found that as of 2011, average hourly rates for home health aides ranged from $16 to $29 across the country, while rates for homemaker aides without medical training ranged from $13 to $24. These rates do not seem to be changing much over time. According to Genworth’s 2012 data analysis, the median rate for in-home care of $18 to $19 an hour nationwide is rising by only 1.15 percent every five years.”
Among the advice on making this sort of care more affordable are reversible mortgages, pensions for veterans that may have previously gone untapped and making alterations to life insurance policies no longer needed to care for others.
“The way this works is that your loved one sells the policy back to the issuing agency for 50 to 75 percent of its face value, an amount determined based on the amount of the policy, the monthly premiums, and the policy holder’s age and health,” the article stated. “There may be restrictions; some policies can only be cashed in if the policyholder is terminally ill. But many are quite flexible. And if yours isn’t, there are settlement companies that will buy the policy, also at 50 to 75 percent of face value, then pay the premiums until the policyholder’s death, when the company will collect the benefits.
“If the company that issued the policy won’t cash it in, don’t worry. Your loved one may be able to sell the policy for a ‘life settlement’ or ‘senior settlement.’ In this case the settlement company pays the premiums until the policyholder dies, then receives the benefits that would originally have gone to the policy’s original beneficiaries.”

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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 “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 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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Court sides with nursing home against woman’s grandchildren

An elderly New York State woman thought she was doing the right thing for her grandchildren.
A court ruled otherwise, in a case of estate planning gone horribly wrong.
The woman, Lillian Hellman, sought to have four annuities, which she obtained in her name with her in control of the accounts, transferred to each of her grandchildren, making her insolvent and eligible for Medicaid once she had entered a nursing home.
Not so fast, nursing home officials said, and a court agreed with them, according to an article on the website
“In 2000, Lillian Heather purchased four annuities for each of her grandchildren as part of her estate plan,” the website stated. “The annuities named the grandchildren as annuitants and beneficiaries, but Ms. Heather retained control of the accounts. Ms. Heather also appointed her grandchildren as her attorneys-in-fact under a power of attorney. In 2006, Ms. Heather entered a nursing home. One granddaughter, Kristin Goldman, signed the admission agreement as her designated representative. After entering the nursing home, Ms. Heather annuitized the annuities and the full value was transferred to the grandchildren. She applied for Medicaid benefits, but the state denied benefits because she had transferred assets for less than fair market value.
“The nursing home sued the grandchildren for fraudulent conveyance, arguing that they had transferred Ms. Heather’s assets for no consideration, rendering her insolvent. The nursing home also sued Ms. Goldman for breach of contract, arguing that Ms. Goldman had access to Ms. Heather’s assets and should have used them to pay for her grandmother’s care.”
The New York Supreme Court in Queens County sided with the Chapin Home for the Aging to the tune of $287,893.95.
“According to the court, it was undisputed that the transfers were made without consideration,” elderlawanswers related. “Moreover, the grandchildren did not present any evidence that the transfers did not make Ms. Heather insolvent. Nevertheless, the court rules that Ms. Goldman is not personally liable for breach of contract because the admission’s agreement did not make the designated representative personally liable.”

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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