The Physical Challenges of Aging in Place

According to AARP aging in place is a goal for 3 out of 4 Americans aged 50 or more. These seniors and near seniors are willing to employ alternative solutions to facilitate this. The alternatives include home sharing (32%), building an additional or accessory dwelling unit (31%) and locating into villages that provide services which enable aging in place (56%). These communities become a source of support and engagement for residents and give a sense of grounding through memories of a long-time home environment.

Seniors who want to reside in a community (aka, age in place) rather than seek residential institutions or nursing homes are mostly dependent on unpaid caregivers and family members for assistance with activities of daily living (ADL). These activities include laundry, self-care actions like bathing and dressing, meal preparation, and transportation. Medicare provides some long-term care services and supports (LTSS); however, the LTSS program falls far short of the need. While the aging population in America is rapidly increasing, lawmakers are slow to respond to the insufficient funding to increase the availability of LTSS for seniors choosing to age in place. The goal of LTSS is not to replace but to supplement the contribution of unpaid family and caregivers. The addition of a Medicare benefit to support family caregivers as they help their loved ones would enable more aging adults to successfully remain in their homes.

Technology has provided some solutions for caregivers, allowing caregivers to monitor their loved one remotely while they stay engaged at work. Smart environmental controls and personal assistants have lightened the load of constant oversight but cannot replace the helping human touch. Nearly 60 percent of seniors who have seriously compromised mobility report being house or apartment bound, while 25 percent of those seniors say they often remain in bed and do not dress daily.

Low tech devices like canes, walkers, ramps, grab bars, shower seats and raised toilets to increase the level of accessibility and safety for aging in place seniors, however, transferring in and out of bed and moving around their homes still provides notable difficulty for many. The senior who wants to age in place is typically independent-minded and therefore have trouble foreseeing a time when help is not a want but a need. Aging adults and their families need to plan to address changing physical capacities before an adverse health event such as an unintended fall or dementia challenges change everything. While aging in place is a great goal for many seniors it requires planning just as if they were planning on moving into an assisted living facility.

Johns Hopkins researchers report 42 percent of older adults who have problems performing ADLs or are living with probable dementia receive no assistance at all from family, friends or paid caregivers. That is a staggering number of unaided seniors. Additionally, twenty-one percent of seniors with a minimum of three chronic conditions and high needs received no assistance at all. LTSS through Medicare will have to make changes to meet the ever-increasing demand for human caregiving.

Approximately 60 percent of at home seniors use at least one low tech device, most commonly for bathing, toileting or in-home movement, throughout their day but their needs multiple as they age. Unfortunately, Medicare does not cover the expenses of most of these nonmedical devices and services. The resulting problem is seniors near, or at the bottom of the income ladder go without assistance, human or device, putting their daily lives in a very precarious position. Hardships for these seniors on the razor’s edge include the inability to pay medical bills or prescription costs, utilities or rent, and some resort to skipping meals to balance out their unaided lifestyle. At best this is heartbreaking, at worst it is inhumane.

The CHRONIC Care Act will allow Medicare Advantage plans to offer supplemental benefits for seniors to cover devices such as wheelchair ramps, grab bars, personal care, and transportation to chronically ill seniors however there are 21 million people who have needs to be met and how this will be paid for is unclear. Meanwhile, the 39 million people enrolled in traditional Medicare are entirely left out of any supplemental benefit. Affordability for at home care is a significant issue on a personal, family, and government level.

Caregivers and assistive low tech devices are an absolute necessity for seniors opting to age in place. The extent of the adjustments senior adults make as their needs become more profound are not well documented. As aging in place is a common strategy now, new solutions and programs must be explored to ensure successful aging.

If your strategy is to age in place, have a discussion early on with trusted counsel and family members to address some of the challenges you will eventually have to overcome. If we can assist you, please don’t hesitate to reach out.

10 Fun Facts About Senior Adults in Honor of the Upcoming National Older Americans Month

The month of May is officially designated National Older Americans Month. Next month we will spend time with this annual opportunity to celebrate America’s seniors, and raise awareness about the many challenges older adults face every day.

Seniors have come a long way since National Older Americans Month was first established under President John F. Kennedy in 1963. At the time, about a third of senior adults lived in poverty and there were few programs to meet their needs. Medicare had yet to be created, and only 17 million Americans, or 9 percent of the population, lived long enough to see their 65th birthday. Today, there are more than 49 million seniors. They constitute over 15 percent of all Americans.

In honor of the upcoming National Older Americans Month, let us share some interesting facts you may not know about our senior population. As always, our goal is to share with you the education and research you and the seniors you love need to plan forward.

1- More than 10,000 “baby boomers” turn 65-years-old every day. 

2- Senior citizens are the fastest growing demographic group on Facebook. Recent studies show that more than half of all U.S. seniors are active online, and more than one-third are on Facebook and other social media websites.

3- Older adults aged 85 and up are the fastest growing age group in the country.

4- There are more than 55,000 seniors over age 100, and by 2050 the number of “centenarians” is expected to top 600,000. This is roughly the population of Vermont. 

5- Seniors account for 40 percent of all drug prescriptions.

6- There are more than 11,400 senior centers across the country that together serve more than 1 million older adults every day. The average age of a senior center participant is 75.

7- More than 15 million older adults are formally recognized volunteers, but nearly half of all seniors volunteer in some capacity.

8- About 65 percent of all “baby boomers” say they plan to work past age 65.

9- Studies show that physical activity can slow the elder aging process.

10- A recent survey found that at least 70 percent of all seniors are still sexually active, and that they reported being just as satisfied, sometimes more satisfied, than when they were younger. 

As you read these statistics, what holds true for you and your loved ones? What help do you need as you plan forward for your future that may include increased elder care needs? Do not wait to contact our office to schedule a meeting to address your questions now, or in the future.

Medicaid Matters: Plan for When Your Ill Spouse Leaves Home

 

You may see it coming: Much as you want to and hard as you try, you just can’t take care of your ill spouse at home any more. At this emotionally difficult time, the last thing you need is the stress of not knowing where to find the money to pay for the steep costs of institutional care.

Advance planning is a must. As soon as you can – ideally at least five years before serious health problems arise – take advantage of many elder attorneys’ willingness to talk with you for free, or for a modest initial-consultation charge.

We are here to help you navigate the complexities of the Medicaid program. This is a governmental fund available to meet the staggering expense of institutional care, but the ins and outs of the qualification rules are complicated and mistakes can be costly. Here’s a thumbnail to help you grasp what your attorney will be telling you.

 

 

Resources” and “Income”: The Difference

Medicaid assistance is available only to those who own very little. The Medicaid rules determine what “owning very little” actually means. A person can only own around $2,000.00 of what Medicaid calls “resources.”

Resources include cash in the bank, CDs, the cash value of insurance policies, investments, and the like. Income includes regular paychecks, Social Security, or payments received for child support. Both income and resources are potentially “counted” by Medicaid as “available.” To qualify for assistance, available income and resources must be carefully spent or transferred away.

 

Exempt Resources

Some resources are not counted or, in other words, are exempt. This means the Medicaid rules exclude them from adding up to the $2,000.00 limit. These resources are sheltered from Medicaid’s requirement that the applicant must spend down almost everything before assistance will be available.

A married couple’s residence, one motor vehicle, household goods and furnishings, medical equipment, jewelry, and other items are exempt. This means that an ill spouse can still qualify for Medicaid assistance even if the couple owns those resources. There’s no need to give them away or sell them to qualify.

The distinction between “exempt” and “non-exempt” assets can be tricky, though, and should first be assessed by a qualified elder-law attorney before any action is taken.

 

What the Well Spouse Can Keep

The Medicaid rules permit a spouse who remains at home to keep a portion of the couple’s resources. This is known as the “community spouse resource allowance” (CSRA). Of course you’d like to see the well spouse keep as much as possible within the CSRA limits. Planning can arrange the distribution of resources to make that happen.

Here is where the difference matters between “resources” and “income.” Medicaid distinguishes between the well spouse’s income and the couple’s resources. Resources over the CSRA limit must be spent down or carefully transferred. As to income, the well spouse can keep it up to a certain level, so he or she will have enough money to live on. The Medicaid rules call this the “monthly maintenance needs allowance” (MMNA).

For example, if the well spouse gets Social Security benefits of only $500.00 a month, but her allowed MMNA is as high as $2,000.00, it makes sense to convert some of the couple’s resources into raising her income up to the MMNA limit. This is not a simple matter, though, and should be done only on the advice of a qualified elder-law attorney.

Planning for Medicaid eligibility can be complicated. Please consult an elder-law attorney as soon as possible. The sooner you plan, the more strategies are available to protect your resources. An initial consultation with a qualified elder-law attorney, for free or for a modest amount, could save you many thousands of dollars.

Don’t delay.

What You Need to Know About Ancillary Probate

If you own a home, a boat, or other property out of state, your heirs might need to go through another probate or court process to receive it. This is known as ancillary probate.

The laws of the state where the property is located will determine how it’s divided, should you not place it within your own trust agreement.  Some things to consider as you plan your estate include the potential difficulties of ancillary probate, such as extra work and legal and accounting fees.  

The Ancillary Probate Process

If you’ve filed a will for property in the state where you live, all probate procedures will start there. The probate court in your home state may need to accept or admit the will with your out-of-state property, if there aren’t any challenges, as a “foreign” will.  The out-of-state court should then also accept it or have its own independent process.

The ancillary probate process is often shorter than the one in the primary state, however, the executor or administrator of the primary last will and testament may need a lawyer in the second (or third) state to handle the procedure. The executor needs the same powers and responsibilities in each state for authority over the property.

Potential Shortcuts

Ancillary probate may be simplified, and sometimes, you can avoid it altogether. State laws differ, so it’s best to discuss with your own attorney to determine how they apply in the locations involved. For example, in the home state, the executor might need only to file letters of authorization and a copy of the will there to avoid having to be appointed executor in the second state. Among the alternatives, if it is a possibility, you could consider small estate proceedings if the property isn’t too valuable.  

Other options for avoiding ancillary probate may include:

  • funding the property into a trust agreement (whether or not a will already exists)
  • a transfer-on-death deed
  • adding a co-owner to the title or joint tenancy with the right of survivorship
  • selling or transferring the property before death

It can be tough to think about the future, especially when time is of the essence. Remember, you don’t have to do it all alone. If you need help on this issue or any other, don’t hesitate to contact us for advice and support.  

Veterans, home health care and technology

Mountain Empire Legal firm logoThe Department of Veterans Affairs (VA) has become an unlikely and innovative pioneer in the quest to provide cost-effective, quality home health care for veterans. Although the agency has long been mired in controversies surrounding its programs, particularly arbitrary caregiver dismissals, the home health services sector of the VA has long been touted as an overall success story. As Thomas Edes, director of comprehensive geriatrics and palliative care programs for the VA puts it “We’re working in this environment of challenging budget constraints, and at the same time, we’re a very mission-driven organization. Put those together and what happens? That really pushes us to innovate.”

This innovation has seen home-based primary care for veterans quadruple since 2000, and all VA medical centers throughout the US now have a palliative care program as well. The VA Medical Foster Home program care has expanded from a pilot to a national program, recognized in at least 45 states and providing veterans housing as well as in-home care. These success stories are great news for veterans and a must for the Veterans Administration in part because the median age of a veteran is now 64 and the US aging veteran population is growing even faster than the senior civilian population.

It is not just the “new-comer” seniors straining the VA health care system. Nationwide the 85 plus population is on track to increase 70% from 2000 to 2020 according to the US Department of Health and Human Services. The overall unsustainability of the US health care system has forced the hand of the VA, and there is no more cost-effective way than through subsidized, at home family and community-centered health care and technology to meet veterans’ care needs.

The Official Blog of the U.S. Department of Veterans Affairs reports that Telehealth is revolutionizing veteran care and providing high-quality treatment for them. The VA Video on Demand is delivering convenient, accessible health care particularly to those 24 plus percent of veterans who live in rural and remote access locations. Telehealth is also important for those veterans who are disabled. Although a veteran might live in a city they might be unable to get themselves to a medical center for an appointment.

Assisted living technologies for veterans include assistive mobility equipment – an ever-expanding category including wheelchairs, all-terrain vehicles, exoskeletons and in-home ceiling track mobility systems. Each of these continue to be refined and specialized to meet the individual veteran’s needs. The Veterans Administration awards grants to develop technology to assist veterans and service members in modifying their homes. Adapted computer access and electronic aids to daily living and environment control units (personal assistants) provide customized interactive abilities for veterans.

Electronic cognitive devices help veterans who struggle with activities of daily living (ADL). These devices include personal digital assistants (PDAs), smartphones, pocket personal computers (pocket PCs) and other handheld devices, global positioning systems (GPS), reminder watches, pagers with reminder features, and digital voice recorders. The use of these devices helps a veteran stay on schedule with medications as well as stay connected with family, friends, and their medical monitoring community. Those veterans with Post Traumatic Stress Disorder (PTSD) are further helped with their ADLs when robots with artificial intelligence (AI) are introduced into their environment. These AI “tech bots” are capable of reading human facial expressions and can identify when a veteran is feeling particularly stressed, isolated, angry, or depressed. The robot can upload the information to the veteran’s caregivers thus alerting them to the need for human intervention. Wearable sensors can also alert a caregiver or medical professional when vital signs are outside of a normal, healthy range.

The VA will provide a payment to disabled veterans toward the purchase of a car or other transportation and additionally will pay for adaptive equipment, repair, reinstallation or replacement of necessary equipment due to disability. If a veteran has lost the use of at least one foot, hand, or has a permanent impairment to their vision or severe burn injuries or immobile joints that their limit mobility, the VA will help to fund the adaptation of the vehicle to make it fully operational to the veteran.

While the latest technology brings benefits to all seniors opting to age in place, the veteran community is especially helped. Many veterans would like the luxury of aging without combat or noncombat injury so inherent to military service. Some of the aging in place obstacles they must overcome are extreme, commensurate with the injuries (psychological and physical) they have endured. Navigating the benefits that are available to a senior veteran is complicated if you are not well versed in the process. Getting enrolled in the correct program and receiving benefits can also be a lengthy process, so it is best to seek help before wasting valuable time.

If you have questions or would like to discuss your particular situation, please don’t hesitate to contact us.

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