Comprehensive Planning. Lifelong Solutions.

Reducing caregiver stress helps prevent elder abuse

By Hook Law Center

Elder abuse has long been associated with the stress caregivers experience when providing care for older loved ones. Reducing caregiver stress is a key factor in preventing the abuse and neglect of elders.

As much of health care moves out of hospitals and into homes, caregivers are charged with providing care to increasingly ill loved ones in increasingly complex ways. At the same time, caregivers experience emotional stress from seeing the physical or cognitive decline of a loved one.

Anyone can be a caregiver, but caregivers are most likely to be middle-aged women who work and who may also be the primary caregivers for their children. The time commitment and physical commitment of providing care can be profound. In some cases, this mounting stress can be a contributing factor to the abuse or neglect of an elder.

Self-care is a key factor in reducing caregiver stress. Caregivers should develop healthy coping skills, such as taking time away from the elder, exercising, socializing or participating in hobbies.

A person’s family and community can also help reduce caregiver stress. For example, community respite programs can give caregivers a few hours to spend on their own needs. Family members can pitch in by becoming secondary caregivers and reducing the load on the primary caregiver.

One complex factor that can contribute to elder abuse and the stress of caregiving is the caregiver’s historical relationship with the elder. If the caregiver was abused by the elder as a child, the caregiver may experience a great deal of stress and complex emotions when caring for the elder now. The same is true for parent-child relationships that were marked by antipathy or apathy in previous years. For such individuals, professional assistance or other options for care may be best.

Posted on Monday, December 29th, 2014. Filed under Long-Term Care.

What is covered by Medicare in a skilled nursing facility?

By Hook Law Center

Many people on Medicare assume that the program will cover any medical costs they encounter, including the cost of care in a skilled nursing facility. However, coverage for care in a nursing home is actually quite limited, and it is only provided under certain circumstances.

Medicare only pays for care in a nursing facility if a patient is admitted to the facility within a month of having been admitted to a hospital for at least 3 consecutive days. In addition, Medicare requires physician certification of the fact that the necessary care can only be provided by an inpatient facility. The Centers for Medicare and Medicaid Services (CMS) must have approved the facility.

For Medicare to cover care in a skilled nursing facility, the patient must need the facility’s rehabilitation services five days a week, or its skilled nursing services seven days a week. If the care could be administered at home by a nurse on a less frequent basis, Medicare will not cover the care in a facility.

Even when care in a facility is covered, Medicare only pays for 100 days of care. For the first 20 days, full coverage is provided. From days 21 through 100, co-payment is required. After 100 days, the patient is required to pay privately until they have exhausted their resources and are eligible for Medicaid.

Medicare charges are monitored by Recovery Audit Contractors, who work for the CMS. These contractors receive a commission for detecting and recovering overpayments, so doctors and hospitals are very motivated to avoid charging Medicare for expenses that are not covered.

Posted on Sunday, December 21st, 2014. Filed under Long-Term Care.

Avoiding retirement planning pitfalls

By Hook Law Center

Although most people are aware of how important it is to plan for retirement, it is easy to fall into retirement planning pitfalls that have significant consequences down the line.
One of the most common pitfalls is money itself. Many people simply do not save enough early
enough. It is recommended that people save enough to have 40 to 60 percent of their pre-retirement income after retiring, depending on their planned lifestyle. The later a person starts saving, the more they need to save each year. In 2015, individuals will be able to contribute up to $18,000 per year to their 401(k)s.

The money saved for retirement should be earmarked only for retirement. A 401(k) is not an
emergency savings account; it is a retirement account, and withdrawals before the age of 59 1/2 are subject to penalties and income tax. To avoid the temptation to take early withdrawals, one may wish to keep emergency savings in a money market account.

Avoidable financial fees can have a substantial impact on a person’s retirement planning efforts. According to, the average American spends about $155,000 in unnecessary fees over the course of a lifetime. Fees that are easily avoidable include ATM fees, credit card fees, overdraft fees, late payment charges and termination fees.

Finally, missing out on a healthy lifestyle can lead to a less robust retirement. Being in good physical shape allows one to enjoy those golden years to which all that retirement planning has been leading. In addition, the financial cost of health care for preventable diseases can be substantial. Eating a diet rich in unprocessed foods, exercising several times a week, and visiting the doctor for routine check-ups can all help secure a happy, healthy retirement.

Posted on Tuesday, December 16th, 2014. Filed under Estate Planning.

Seniors and their families should apply good judgment in considering nursing home placement services

By Hook Law Center

Nursing home placement services, which offer to help find the perfect housing for seniors, are a growing trend in elder care. These services are offered for no charge, and they claim to demystify the world of elder care facilities. However, seniors and their families should use good judgment in choosing a nursing home placement service.

Senior placement services are completely unregulated, and they do not require licensing or training. This means that anyone can start one, and that quality is not guaranteed. All nursing home placement services stay in business by working with a network of nursing homes,
assisted living facilities or retirement communities. These facilities pay a commission to the placement service when a senior moves in.

The quality of services offered by a nursing home placement service can vary widely. There are some national and franchise operations that work entirely over the phone or online. Often, the consultants at such companies have not actually been to the facilities they are recommending. These companies tend to simply provide a list of communities for the senior to visit.

There are some gems. Small, local companies are often home to experts in senior care who provide a more hands-on service. At these companies, consultants work with seniors in person, take seniors and their families on facility tours and have the expertise to identify a senior’s individual needs. A highquality firm will spend ample time with a senior and follow up once the senior has been placed.

Due to the risk of being misled by a nursing home placement company, seniors and their families should do their research before settling on a company. The company should offer in-person services and be embedded in the local community. Often, but not always, small firms provide better service.

Posted on Friday, December 12th, 2014. Filed under Estate Planning, Long-Term Care.

Aid and Attendance benefit can help veterans who need long-term care

By Hook Law Center

Veterans who need long-term care services like in-home care or residence in a nursing home can receive financial assistance through the Veterans Administration (VA) pension benefit Aid and Attendance. This often-overlooked benefit provides money to veterans who need help with day-to-day tasks.

The pension is designed for veterans and surviving spouses who require help to perform activities of daily living (ADLs), such as dressing, eating, bathing or going to the bathroom. Individuals who are blind or live in a nursing home qualify for the pension.

Aid and Attendance is available to veterans who served for at least 90 days, with at least one of those days occurring during wartime, and to their surviving spouses. The disabilities do not need to be service-related.

To quality, the veteran or surviving spouse must own less than $80,000 in assets, with home and vehicle not included in this calculation. His or her income must also be lower than the Maximum Annual Pension Rate (MAPR), which is currently set at $21,107 for a single veteran. The income calculation does not include welfare benefits, unreimbursed medical expenses that have been paid or Supplemental Security Income.

Even veterans who have an income too high to qualify for a VA pension may qualify for the Aid and Attendance pension, so long as they have high medical costs that are not otherwise reimbursed.

The VA pays the difference between the veteran’s income and the MAPR, so the amount that a person receives from Aid and Attendance depends on his or her income.

Posted on Friday, November 28th, 2014. Filed under Senior Law News, Veterans' Benefits.

Older people without children may wish to designate a caregiver

By Hook Law Center

Older adults who do not have children do not have the built-in support system from which many people with children benefit, which puts them at risk if they become ill or injured. In order to ensure they receive good care that is in alignment with their wishes, these individuals should designate a caregiver while they are still healthy.

This is especially important today, when the number of childless Americans is higher than in the past. In 2010, nearly 19 percent of women ages 40 to 44 had not given birth, compared with about 10 percent in 1980.

A healthcare power of attorney allows a person to appoint someone trusted, whether natural child or friend, to make medical decisions on his or her behalf in case the person is incapacitated. This can be combined with a financial power of attorney, which appoints a trusted individual to handle a person’s finances. Without these documents, it can take time for the court to appoint a guardian. The guardian may not be someone the individual even knows.

In addition to designating a caregiver, it is important for childless older adults to use these documents to make their wishes clear. For example, some people prefer to receive in-home care, while others would like to move to an assisted living facility if long-term care became necessary.

Many childless adults appoint their partners or siblings as their health care agents. However, this carries some risk if the other person is close in age. It is best to also appoint a backup caregiver as well, such as a niece, nephew or friend. It is essential to discuss these issues with the person appointed.

If there is no one available to serve as a healthcare agent, a bank or other company with a trustee department can be employed to make the arrangements.

Posted on Tuesday, November 18th, 2014. Filed under Long-Term Care, Senior Law News.

To help prevent elder abuse, address caregiver stress as it emerges

By Hook Law Center

Elders are among the most vulnerable populations, and they are at special risk for abuse at the hands of their caregivers. Caregiver stress is one of the biggest contributing factors to elder abuse, and stressed-out caregivers are the most likely to abuse.

Depression and anxiety are common among caregivers, who often provide hours of care each week for years on end. Caregivers face about twice the risk of developing depression and anxiety as the general population.

Caregivers often face social isolation due to the time commitment associated with caregiving. Even caregivers who take their elder into their own home still experience financial strain as a result of the caregiving. Caregivers often neglect their own physical and mental health because of the numerous other demands they face.

Addressing these stressful issues can help prevent elder abuse from occurring. Self-care methods like eating well, exercising and using stress reduction techniques can help give caregivers the energy to provide good care for their loved ones. Support groups and counseling can help caregivers to manage stress and other emotions in healthy ways.

Additionally, caregivers should be willing to ask for help. They should be aware of resources in the community and make use of them as needed. Friends and family may be able to stay with the elder for a few hours, or a local respite care agency can provide temporary care. Elders can also spend the day at adult day care. Caregivers should be able to reach out when overwhelmed. That ability reduces the likelihood of elder abuse.

Friends and family members of caregivers can help to take the stress off overextended caregivers. Regular visits and offering to stay with the elder so that the caregiver can get a break can have a profound impact.

Posted on Tuesday, September 30th, 2014. Filed under Estate Planning.

How to make homes safer for seniors

By Hook Law Center

Older adults who continue to live independently at home will need a safe space in which to live. Making the home safe is essential for preventing injuries.

Each year, around 7,000 elderly people die in accidents at home, while millions more sustain serious injuries there. Falls are the most common cause of injury. Drowning in the tub and being burned by the stove or by hot water are also significant risks.

A home that is optimized for safety can allow older adults to continue to live independently for as long as possible. Visiting and taking the house tour is a great start for identifying potential home hazards. People with medical issues, such as poor vision or rheumatoid arthritis, can benefit from a home assessment by an occupational therapist (O.T.).

Many safety improvements are very simple and affordable. For example, removing any unsecured rugs and maintaining good lighting throughout the house and yard can prevent falls, as can maintaining a clutter-free home.

Other common safety improvements include the installation of stairway lifts for indoor stairs and threshold ramps and railings for the approach to the house. It may be necessary to install bars and a specially designed shower or bathtub.

Although health insurance should cover home assessment by an O.T., it will not usually cover home upgrades. However, people with long-term care policies may be able to get coverage for home modifications.

Posted on Monday, September 22nd, 2014. Filed under Estate Planning.

Eye and smell tests may make early detection of Alzheimer’s possible

By Hook Law Center

Results of four new research trials suggest that changes to the eyes and ability to smell may be valuable in the early detection of Alzheimer’s. 

Reports presented at the 2014 Alzheimer’s Association International Conference in Copenhagen revealed that eye exams could be used to identify build-up of beta amyloid in the brain, while a decreased ability to identify odors may be an early sign of cognitive impairment.

Alzheimer’s disease is characterized by the development of brain plaques, and beta-amyloid is their primary component. Plaques start to develop years before cognitive decline and memory loss. In two of the studies, measuring the level of beta-amyloid in the eye correlated with brain beta-amyloid levels and was accurate in identifying people with Alzheimer’s.

In the other two studies, loss of brain cell function and the progression to Alzheimer’s disease was associated with a decreased ability to identify smell.

These findings point to potential avenues for early detection of Alzheimer’s through biomarkers. However, more research is needed to develop these tests.

Currently, Alzheimer’s can only be detected late in the disease, after significant cognitive decline and memory loss has already occurred.

There are no effective treatments currently available for any stage of the disease, although some drugs are effective for a few months for some of the people who take them. Alzheimer’s treatment is primarily symptomatic, aimed at helping patients maintain their quality of life and keeping them safe.

If early detection tests were developed, their primary purpose would be to identify patients early on in the disease process for participation in clinical trials for treatment and prevention of Alzheimer’s.

As effective treatments are eventually developed, early detection could be used to intervene and provide treatments early in the development of Alzheimer’s, before significant memory loss and cognitive decline has occurred.

Posted on Sunday, August 31st, 2014. Filed under Estate Planning, Long-Term Care.

Seniors may qualify for Medicaid by spending down assets safely

By Hook Law Center

Federal law dictates that only someone below a benchmark level of assets can qualify for Medicaid, beyond which it is determined that the individual does not have the assets to pay for his or her own care. Many seniors who apply do not receive Medicaid because their asset level is too high to qualify.

In order to qualify for Medicaid, it is sometimes prudent to “spend down” assets in order to reduce their value. Spending down should be done carefully, ensuring both continued financial security and the receipt of Medicaid.

Not all assets influence whether an individual can receive Medicaid, and these assets do not need to be spent down. A person’s home, car and physical possessions may not be counted. Prepaid funeral and burial arrangements and some cash may also be exempt. However, exemptions are determined on a case-by-case basis.

Medicaid programs allow individuals to spend down their assets on certain expenses. Assets may be used to pay off credit cards, mortgages or loans, including prepayment. They may be used for the prepayment of certain burial and funeral expenses.

The applicant can also use their existing assets to purchase an exempt asset, such as a home or automobile that meets the requirements for exemption. Assets can be used in the upkeep of non-countable assets, such as home repairs.

For people who are married, purchasing an annuity for the spouse can be an excellent way to spend down assets. An annuity guarantees the spouse a fixed income for a given number of years. Annuities purchased for the purpose of spending down must be non-transferable, and Medicaid must be listed as the primary beneficiary after the spouse’s death.

There are certain expenses that should not be used for spending down. For example, prepayment of caregiver services or other services is considered a gift and will actually cause the applicant to be ineligible for Medicaid for a period of time.

The process of spending down to quality for Medicaid can be complex. An estate planning attorney can assist in developing Medicaid planning strategies that are compatible with Virginia’s Medicaid regulations.

Posted on Wednesday, August 27th, 2014. Filed under Estate Planning, Medicaid.
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