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I was at a family reunion recently, and I overheard a lady say that one of the challenges of getting old is seeing your parents aging. This lady is probably in her late 50’s and she is the caregiver for her mom, who is in her 80’s, with very serious health problems.
Speaking with the owner of a relatively large business recently, he said that many of his employees are needing to take time off from work. This is because they are caregivers for their parents. This is a sign of the times, and there are an increasing number of people dealing with these issues.
Most of our presentations and educational content are focused on our clients, whether its retirees in their 60’s or seniors in their 70’s and 80’s. We do estate planning across the generations, but given the increasing number of caregivers taking care of their parents, I wanted to reach out to the caregivers. The title of this blog “What to think about when the unthinkable happens”, refers to what we should think about and do as caregivers, if a parent becomes sick or passes away.
Estate planning is really about the management of control and access. The ‘control’ aspect refers to who is making the decisions, and ‘access’ refers to what is allowed with regard to the finances. If my client has a stroke, or gets dementia, they may have mental faculty issues. As a result, they may not be able to manage their own affairs as they used to. If you notice your parent’s health is declining, as caregivers you need to consider the following:
The first thing you need is a document called a financial power of attorney, which shifts control when someone needs assistance. There are essentially two types of Power of Attorney documents:
A springing power of attorney is based on the idea that you sign the document while you have the capacity, so that should anything happen, your child can take over. The problem is that nobody ever admits that they are losing capacity, especially if they have dementia. It then becomes a battle if the child needs to use the power of attorney, to act on behalf of a parent.
The other type is a durable power of attorney, which you sign while you have your mental faculties. However, the document is effective immediately even if your child may not use it immediately. This type of Power of Attorney is preferred in most situations. Since dementia is progressive in nature, there will likely be a gradual decline in a senior’s mental capacity. Over time, the child caregiver will need to take more responsibility to help their parent. Eventually the time will come when the parent cannot manage on their own. This is the time when the durable power of attorney will work, and is the primary way to plan for someone’s incapacity.
Another suggestion is to consider doing some asset protection, using an asset protection trust. I recommend these trusts for middle class and upper middle class families who are concerned about long term care expenses. We can work with you to create these trusts. The system in this country often results in seniors going broke if they need long term care. Nursing homes in Pennsylvania cost $180,000 a year and most people can’t afford to pay that. Only when you are broke, can you get Medicaid benefits to pay the nursing home. Medicaid is the only payment source for long term care, and it’s important to understand the rules of Medicaid. One of the rules is that if you have transferred assets to an asset protection trust ahead of time, those assets are protected from long term care costs.
If you have a parent who is starting to slip, they may need long term care at a later stage. Please take the time to understand the different types of facilities available to provide care for your loved one. We help our clients with this aspect, and we have a social worker on our team who is familiar with the different facilities. We help people find good care, which I believe is part of doing good estate planning.
While you are taking care of a loved one, if you are a caregiver, you must get the resources to help you to take care of yourself. Here is link to a website with information on caregiver resources: https://www.hospiceandpalliativecareofkodiak.org/caregiver-resources. Jennifer who started this company did so after being a caregiver. She realized the many challenges that caregivers face from an emotional standpoint. You are not in this alone and you also need the support.
When we talk about the ‘unthinkable’ happening, we are talking about losing a loved one. Perhaps you’re the executor and you are wondering what you should do first if your loved one passes away. Let me reassure you that there is no legal or financial emergency that needs addressing in the first 48 hours. If you have just lost someone dear to you, allow yourself time to grieve. When it comes to the estate administration process, it is a marathon and not a sprint. This is especially pertinent when it comes to probate cases. Please contact the Sechler Law Firm or your estate planning attorney, to get help with the estate administration process.
Managing the financial aspects of long-term care for elderly loved ones can be a complex and challenging task for family caregivers. From planning for in-home support to exploring options like assisted living or nursing home care, the financial burden often adds to the already significant emotional and physical responsibilities they face. This article offers an overview of financial strategies and insurance options, providing valuable insights to help family caregivers navigate the complexities of long-term care planning and ensure their loved ones receive the care they need without undue financial strain.Understanding Long-Term Care NeedsLong-term care involves a variety of services designed to support seniors who need help with daily activities and medical care over an extended period. Whether its assistance with tasks like bathing, dressing, or managing medications, long-term care ensures that seniors are safe, comfortable, and well-cared for. The type of care can vary, from in-home support, where assistance is provided in a familiar environment, to more structured settings like assisted living facilities and nursing homes that offer continuous care and supervision. A study by Genworth Financial found that the average annual cost of a private room in a nursing home in 2023 was $108,600. Knowing the available options can help families make the best decisions for their senior loved ones.Cost Factors of Long-Term CareThe cost of long-term care is a significant consideration when planning for the future. Several factors affect these costs, including the level of care needed, where the services are provided, and how long the care will be required. For instance, in-home care may be more affordable than nursing home care but can still add up if ongoing daily assistance is necessary. Assisted living facilities offer different levels of support and amenities, while nursing homes typically provide the highest level of care at a higher cost. Nationally, costs can range from around $4,500 per month for assisted living to over $9,000 per month for nursing home care, depending on location and the level of care. Understanding these factors is key to ensuring that senior loved ones receive the best care within the familys financial means.Assessing Your Loved Ones Financial SituationFor family caregivers, understanding the financial situation of an elderly loved one is a critical step in planning for long-term care. Its essential to evaluate current assets such as savings, pensions, and Social Security income to determine how these resources align with future care needs. This process involves reviewing total assets, including any investments and retirement funds, and comparing them to the monthly income your loved one receives, such as Social Security benefits or pension payments. Recognizing potential gaps between current income and anticipated care expenses is key to making informed decisions about long-term care options and exploring any additional financial support that may be required.Tracking and Organizing Financial DocumentsMaintaining accurate and organized financial records is crucial for caregivers managing long-term care planning. Its important to collect all relevant documents, such as medical bills, insurance policies, and bank statements, and ensure they are easily accessible. Establishing an organized system, either digitally or through physical filing, can help caregivers keep track of essential items like wills, power of attorney forms, and healthcare directives. A survey by AARP found that 84% of caregivers reported that managing their loved ones finances was stressful. This ensures that financial records are in order and available when needed, making it easier to navigate care decisions and avoid any confusion down the line. Properly organizing these documents is a practical step in preparing for the evolving needs of elderly loved ones.Building a Long-Term Financial StrategyCreating a solid financial plan for long-term care is essential to ensure elderly loved ones receive the care they need. With rising healthcare costs and uncertain future expenses, its important to build a strategy that addresses both current and future needs. This includes budgeting for ongoing care, preparing for unexpected costs, and seeking professional financial advice. Here are key considerations for developing a long-term care strategy.Creating a BudgetFamily caregivers face the challenge of creating a realistic budget to cover the many costs associated with caring for an elderly loved one. This involves accounting for essential expenses such as healthcare, housing, and daily living costs like food and transportation. A study by the National Alliance for Caregiving found that 36% of caregivers reported moderate to high levels of financial strain due to caregiving responsibilities. Additionally, planning for potential future costs, including inflation and evolving care needs, is important. By developing a flexible budget, caregivers can better manage unexpected expenses, such as medical emergencies or necessary equipment, ensuring their loved ones receive continuous support without straining financial resources.Establishing an Emergency FundAn emergency fund is a crucial financial safety net for caregivers, providing a buffer for unforeseen medical situations or urgent care needs. Ideally, this fund should cover at least three to six months worth of expenses, but caregivers can start small and build over time. Setting aside even a small portion of monthly income can make a significant difference in handling unexpected costs without disrupting overall financial planning. Having this financial reserve helps caregivers feel more secure in managing the unpredictable nature of caregiving.Working with a Financial AdvisorCollaborating with a financial advisor or elder law attorney can be a valuable step in long-term financial planning. These professionals offer guidance on more complex financial matters such as tax benefits, estate planning, and managing long-term care insurance. They can also help caregivers navigate legal issues like power of attorney and healthcare directives. Engaging with a financial expert ensures that caregivers are well-prepared to manage both present and future financial responsibilities for their loved ones, reducing stress and providing peace of mind. Exploring Insurance Options for Long-Term CareWhen planning for long-term care, understanding the available insurance options is crucial for family caregivers. Different programs and insurance plans can help cover the costs of care, but its important to know what each offers and the requirements for eligibility. Below are key options that can assist in managing long-term care expenses for your elderly loved ones:Long-Term Care Insurance:This insurance helps cover costs for in-home care, assisted living, and nursing homes. Its best for those wanting to protect savings, and purchasing early helps keep premiums lower. Eligibility is based on factors like age and health, making early consideration important.Medicare and Medicaid: Whats Covered:Medicare only covers short-term care, not long-term services like nursing homes or ongoing in-home care. Medicaid covers long-term care but has strict income and asset requirements. Understanding both programs helps caregivers plan effectively for care costs.Veteran Benefits:Veterans may qualify for benefits such as Aid and Attendance to assist with long-term care expenses. Exploring these options can ease financial strain for veterans and their families, so knowing eligibility and applying is crucial.Government Programs and AssistanceWhen caring for elderly loved ones, government programs can provide crucial financial support for long-term care. Understanding how these programs work and how to access them can help ease the financial burden on family caregivers. Social Security BenefitsSocial Security can be a vital source of income for elderly loved ones, helping to cover some long-term care costs. While it wont cover all expenses, it can assist with daily living costs or contribute to care services. However, its important to be aware of how Social Security benefits might impact Medicaid eligibility, as receiving benefits could affect qualification for certain programs.Medicaid PlanningMedicaid is one of the most important resources for covering long-term care, especially for those who have limited financial means. Qualifying for Medicaid can be complex, requiring careful planning to meet income and asset requirements. Early Medicaid planning is essential, as it allows you to make the most of the available benefits and ensure that your loved one qualifies when the time comes.Legal Considerations and Planning AheadPlanning ahead for legal matters is crucial to ensure elderly loved ones are protected and their wishes are respected. Setting up the right legal documents early can provide clarity and make decision-making easier as care needs evolve. According to a study by the National Academy of Sciences, Engineering, and Medicine, only 23% of adults have a living will or other advance directive. Here are key legal considerations for family caregivers to keep in mind:Power of Attorney and Healthcare Directives: A durable power of attorney allows a trusted individual to make financial and healthcare decisions on behalf of an elderly loved one if they become unable to do so. Healthcare directives, like a living will, ensure that medical preferences are respected. Having these documents in place helps avoid confusion and ensures decisions align with your loved ones wishes.Wills, Trusts, and Estate Planning: Proper estate planning protects assets and ensures financial wishes are followed. Wills and trusts can help minimize long-term care costs, preserve wealth, and avoid probate. Early planning is essential to safeguard an elderly loved ones financial future and provide peace of mind for the entire family.Starting Financial Conversations: Talking about finances can be challenging, but its an important step in planning for the future. Approach these conversations with respect and transparency, allowing your elderly loved one to express their concerns and preferences. Open communication ensures that financial decisions reflect their wishes and contribute to better care planning.Planning for the UnexpectedWhen caring for elderly loved ones, family caregivers must be prepared for sudden changes in care needs. A decline in health, unexpected hospitalizations, or the need for more intensive care can create financial challenges. A survey by the Alzheimers Association found that 39% of caregivers reported significant financial strain due to unexpected expenses related to caregiving. Planning ahead by building an emergency fund and understanding what insurance covers can help ease the burden. Regularly reviewing and adjusting the financial plan ensures caregivers are ready to adapt to these changes without causing unnecessary stress.At the same time, its essential for caregivers to maintain their own financial well-being. Balancing the needs of a loved one with personal financial goals is crucial to avoiding long-term strain. Setting boundaries on financial contributions, continuing to save for the future, and seeking professional financial advice can help caregivers manage these responsibilities while protecting their own financial health. Taking care of their finances ensures caregivers can provide support without compromising their own stability.In summary, effective financial planning is key to ensuring that elderly loved ones receive the care they need while reducing the stress on family caregivers. By exploring insurance options, setting a budget, preparing for unexpected changes in care, and addressing legal matters, caregivers can create a strong financial foundation. Starting early and seeking professional guidance helps avoid financial surprises and ensures that both the caregiver and their loved one are better prepared for the future, providing peace of mind and the ability to focus on what truly mattersquality care.
Change can be daunting at any age, but for seniors, adjusting to a new living environment can be particularly challenging. Whether moving into a retirement community, downsizing to a smaller home, or transitioning to an assisted living facility, the process can evoke a range of emotions and concerns. As caregivers, family members, or friends, it's important to recognize our responsibility to provide support and guidance during this transition period. Here are some valuable tips on how to help a senior adjust to a new living environment.Start with Open Communication: Before the move, engage in open and honest conversations with the senior about their feelings, fears, and expectations regarding the transition. Listen attentively to their concerns and validate their emotions. Reassure them that their feelings are normal and offer your support whenever possible.Familiarize Them with the New Environment: Visit the new living environment together before the move, if possible. Explore the surrounding neighborhood, and introduce them to staff members and fellow residents. Familiarizing them with their new surroundings can alleviate anxiety and make the transition feel less overwhelming.Personalize Their Space: Help personalize their new living space to make it feel more like home. Bring familiar items such as family photos, a favorite comforter, and cherished mementos to decorate their room or apartment. Creating a comfortable and familiar environment can provide a sense of security and belonging.Establish a Routine: Create a sense of normalcy by establishing a daily routine. Consistency and structure can help reduce feelings of uncertainty and anxiety. Set regular meal times, exercise sessions, and leisure activities to provide stability and promote a sense of control over their environment.Encourage Socialization: Gently urge participation in social activities and engagement with other residents or neighbors. Building connections and forming friendships within the community can combat feelings of loneliness and isolation. Attend group events, classes, or outings together to facilitate social interactions and foster a sense of belonging.Provide Emotional Support: Be patient and empathetic as your loved one navigates the challenges of adjusting to their new living environment. Offer emotional support and encouragement, and remind them that it's okay to feel unsettled or homesick initially. Validate their emotions; do not try to talk them out of their feelings. Reassure them that they are not alone in this transition.Seek Professional Assistance: Professional assistance from a counselor, therapist, or support group specializing in senior transitions can be a helpful resource if coping with the transition becomes too much of a struggle. Professional guidance can often facilitate a smoother adjustment process in new surroundings.Senior Care Authoritys Peace of Mind Program: Our Peace of Mind program eases the stress of the move-in by providing extra support, verifying post-move-in needs and wants, and helps set realistic expectations between the resident, family, and staff. Our Peace of Mind program offers: Weekly visits to your loved one, an engaging activity, guided by family input, communication with care home, senior living community, medical providers, or others on your behalf, Our experts can provide an extra set of eyes on your loved one. Simply put, we are able to be there when you cannot.Helping an older adult adjust to a new living environment requires compassion and understanding. Remember to be patient, stay involved, and practice self-care along the way. With support and guidance, you can help someone can embrace their new living environment and thrive in this next chapter of their journey. Senior Care Authority experts are here to help. You dont have to do this alone.
What We Dont Know We Dont Know in Health Care: September 24, 2024 -Oral Care, Monitored Meals, and Aspiration PneumoniaProper oral care is crucial for maintaining optimal health. Keeping the mouth clean not only helps maintain the protective properties of saliva but also reduces bacteria in the mouth which can be a source of infection in aspiration pneumonia. In addition, monitoring meals and assisting with feeding for those at high risk for aspiration is also a necessity. The process of swallowing involves dozens of muscles that start in the mouth and include the pharynx, larynx, and esophagus. These muscles can become weakened with age and from various, often age-related diseases. The aging population is especially at risk for aspiration pneumonia due to comorbidities, frailty, and conditions that can impair swallowing. As a result, aspiration pneumonia is one of the leading causes of death from infection in individuals over the age of 65. One study shows that 1 in 10 deaths from pneumonia in elderly nursing home residents may be prevented by improving oral hygiene (Sjogren et al., 2008). Unfortunately, proper oral care and monitoring of meals is often overlooked in the health care setting. Perhaps the greatest reason for this is the challenge that almost every health facility faces today: adequate staffing. When I started working in acute care as an RN over 20 years ago, nursing assistants (these are the staff generally responsible for proving oral care in an acute care setting) were typically responsible for 5-7 patients. Nurses had 3-5 patients (this was on a step down cardiac unit). Between the nurse and the assistant, we were able to provide oral care at every meal and offer one-on-one assistance to any patient that was at risk for aspiration. This is no longer the case. RNs oftentimes look after upwards of 8 patients, and there is generally either no nursing assistant on the floor or only 1 for a patient load that can exceed 20. Consequently, proper oral care is neglected. I have often seen patients that are aspirating during meals, but do not have adequate staffing on hand to provide them with the supervision and monitoring that they need. This presents a hazardous catch-22: the aging individual needs to eat to maintain nutritional needs yet he/she needs assistance with eating to prevent aspirating pneumonia. How can this be remedied? If the family is present, they can provide oral care and meal monitoring. If meal monitoring is required for an at-risk individual, its recommended to touch base with the health care team to inquire as to what the specific aspiration precautions are (every individual may have a different need and/or recommendation). A care companion can also be hired to provide the needed care. I hired a companion for my father when he was in a skilled nursing facility. He was not getting his teeth brushed or flossed regularly, and I was seeing a decline in his dentition. Having this extra support provided him with much needed assistance and the care companion had the added benefit of encouraging him to eat more at every meal, something that was a bonus as he was not meeting his nutrient needs. Touching base with staff to request that oral care and meal monitoring be done can also be helpful. Having an advocate to ensure necessary care is getting done can also be very effective in the health care setting. What is proper oral care and effective meal monitoring? Proper oral care includes brushing the teeth for at least 1 minute after every meal. It also includes using a soft bristle brush, fluoride toothpaste, flossing daily. A final component of oral care that is often not discussed is denture care. Dentures should be cleaned at least once per day and removed at bedtime. Removing them prior to sleeping can greatly reduce the risk of pneumonia (Iinuma et al. 2014). Effective meal monitoring includes adequate supervision during mealtime for those at risk of aspiration. Such supervision includes ensuring the individual is properly positioned for a meal (head of bed as high as can be tolerated and supine position), takes small bites, eats slowly, swallows a couple times in between each bite, and intermittently takes a sip of liquid to clear the mouth of food particles. The use of straws is generally not recommended for an individual at risk for aspiration as it propels the food to the back of the throat and hence can increase risk. I recall when I was working as a Registered Nurse (RN) in acute care that I was constantly removing straws from the bedside of at risk individuals and often reminding them to eat slowly and swallow at least twice between each bite to ensure food clearance. Individuals at risk for aspiration often require a modified texture diet as it can further prevent the aspiration of food and liquids. This is a brief summary of the attention to detail needed in addressing oral hygiene and meal monitoring amongst the aging population. Both measures can play a significant role in reducing aspiration pneumonia. If you would like more information on understanding proper oral care or any other questions that you may have regarding aging life care, please feel free to reach out to me. Sources:1. Sjogren P, Nilsson E, Forsell M, Johansson O, Hoogstraate J. 2008. A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials. J Am Geriatr Soc. 56:21242130. 2. Iinuma T, Arai Y, Abe Y, Takayama M, Fukumoto M, Fukui Y, et al. 2014. Denture wearing during sleep doubles the risk of pneumonia in the very elderly. J Dent Res. doi: 10.1177/0022034514552493 3. F Muller, 2015. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541086/#
At Sechler Law Firm, LLC, our mission is to help families make great plans. A great estate plan is more than just a set of documents. It is a comprehensive and well thought out written strategy on how to deal with lifes unfortunate twists and turns. Our process first provides you with the education necessary to make informed decisions with regard to your planning. Then we put the proper documents and legal framework in place to respond to lifes unfortunate changes.Our Estate Planning law office is headquartered in Cranberry, PA. From this office, we happily serve the residents of Cranberry, Mars, Wexford, Pittsburgh, Butler and the residents of surrounding communities. As one of the regions only Certified Elder Law Attorneys, Tim Sechler and his team often assist families from across Western Pennsylvania.We understand that the pursuit of health, wealth and happiness is the goal of most families. We want you to be able to pursue these goals, or whatever goals you may have, knowing that you have a back up plan if life throws you a curveball like a death, disability or nursing home need. With education as our foundation, we will work with you to make decisions to Shield What Matters Most to you.Practice AreasEstate PlanningCustomized planning doesnt have to be difficult for you. We strive to make the process easy. The first step is to identify your concerns so that we can make suggestions regarding your plan.Elder Law Crisis PlanningA significant percentage of our practice is dedicated to helping families navigate the long term care maze. We help with Asset Protection and eligibility for Medicaid and Veterans Benefits.Trust And Estate AdministrationIf you have lost a loved one, we can help you take the necessary steps to help handle their affairs.Tims estate planning practice is focused on guiding clients through the complicated maze of balancing transfer strategies, wealth preservation, and family values in the planning process.Tim is a Combat Veteran, having served in Afghanistan as a member of the West Virginia Air National Guard. Prior to leaving the military, Tim had attained the rank of Staff Sergeant. His experiences in the military have led him to thoroughly enjoy working with Veterans and their families.Tim received his law degree from Duquesne University School of Law, and his Master of Business Administration from the Duquesne University Donahue Graduate School of Business. He received his Bachelor of Science in Business Administration from West Virginia University, majoring in Finance. Tim is licensed to practice Law in Pennsylvania and West Virginia.Recently, Tim has been seen frequently as a guest on KDKAs Pittsburgh Today Live, and has been quoted in several local print publications. For the last several years, he has been honored to be chosen as a Super Lawyers Rising Star, an award given to less than 2.5% of Tims peers. Tim enjoys educating the public about Elder Law and Estate Planning. He has spoken to thousands of people regarding estate planning and has averaged more than 50 speaking events per year.Tim became a Certified Elder Law Attorney* in 2017. A CELA is more than just an attorney who specializes in the field of elder law. CELAs are committed, through certification, to maintaining and improving their proficiency with continual practice and continuing legal education. Becoming certified in elder law validates a lawyers specialty to handle issues that affect senior citizens.Tim and his wife, Robyn, are raising three beautiful children in their home in Mars, PA.*Certified as an Elder Law Attorney by the National Elder Law Foundation.