Pennsylvania - Pittsburgh

As an estate planning and elder law attorney, I am becoming increasingly frustrated to see how the long term care system is failing our seniors. I had a conversation with a client this week, who feels that the government programs supporting seniors are broken. My clients mom is in a nursing home and we are assisting them to get Medicaid eligibility to pay the nursing home. What he said really resonated with me, because people are continuing to go broke due to the long term care system.In a recent podcast, I discussed the article that was published in the news, about the baby boomers being the wealthiest generation in history. However, 70% of the wealth is concentrated in 7% of the population. Most of the people we work with are the middle-class baby boomers, who are part of the other 93% population. They own their house and have some money in the bank. Most of them have worked for 40-50 years trying to save a nest egg for their retirement. They have been sold this story that they will have healthcare coverage with Medicare when they retire at 65, and believe they will be taken care of should they get sick.Medicare Wont Pay for Long Term CareUnfortunately, Medicare wont pay for long term care. We help many families every month, going through the process of trying to gain eligibility for Medicaid benefits to pay for long term care. This requires some dramatic legal moves and I can appreciate why my clients feel so frustrated.On the long term care website, I read that around 70% of baby boomers are going to need some form of long term care if they get dementia or Alzheimers. Added to that, 20% of those seniors will need long term care for more than five years. Given the cost of nursing homes in this country, which is $150,000 a year, this is unaffordable for most families.The Future is Uncertain, But We Can Still PlanWe dont know what the future holds, and we cannot prevent the likelihood of getting dementia. However, we can take steps to protect ourselves and avoid going broke. If I end up with dementia, I want to make sure my wife has a house to live in and some money in the bank. We meet many families who want to protect themselves from this system, and ask us to advise them. Some people tell us they already have a will and want to know why they need an estate plan. I understand their confusion when I advise my clients that they need more than a Will. It is unfortunate that the attorney they worked with previously, only offered them a Will. This could be because they met with attorneys who work with clients that have a high net worth. They may also have gone to a general practice law firm, who deals with divorces, traffic tickets and Wills, and not estate planning. The attorneys, financial advisors, tax man and nursing homes know that there are ways to avoid seniors going broke, but none of them are doing anything to help.A Will Is Not EnoughA Will only states who will get your stuff when you pass away. Estate planning is not only about who gets your stuff when you pass away but it helps to provide a sense of security, by protecting your house and money. You have worked for your money, and you should keep it not the government or the nursing home. I want to ensure you have a peaceful retirement, without worrying about going broke to pay for long term care. If you need more than five years of long term care, you definitely want to protect your assets.Many of my clients like to use trusts, and I recommend putting your house and some money into an irrevocable asset protection trust. This means that after five years, the house is safe from any claims from the nursing home. You would have to give up access to the equity of the house, assuming of course you wont need to do a reverse mortgage. You also wont receive a distribution from the trust. However, you can still live in your home, but the difference is your house is now protected from the nursing home if you get sick.You Can Avoid ProbateIf you have IRAs, they will need to be beneficiary designated, and will avoid probate. You can put any other money you have that you want access to, in a revocable trust. Having your house in the asset protection trust and money in a revocable trust, will allow you to avoid probate. Your life wont change, but a large percentage of your net worth is protected from long term care costs. This in my opinion is a much better estate plan for you.We will help you to establish a Power of Attorney, as well as health care planning. The result of planning like this, is that you dont have to worry about the nursing home, or probate. We also teach your children, who are the future executors and trustees, about their future roles and responsibilities. Handing legal documents to your adult child and expecting them to know what to do is unfair and unrealistic. Do The Right Thing Get An Estate Plan To learn more about doing good planning for your family, come to one of our Three Secrets Workshops. I am sure you want to have a good retirement without worrying about anything intercepting your inheritance to your kids. Our free workshops will teach you all you need to know to make informed decisions. You will then be able to have the best estate plan for you and your family. By offering the education in a classroom setting, it makes it more affordable for you to do estate planning. Visit sechlerlawfirm.com/workshops to register for a workshop now.

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/#   

The holidays can be an emotional time for older adults, and this is especially true for a loved one living with Alzheimers or another form of dementia. The thought of planning a holiday celebration while caring for your loved one can feel overwhelming, but it doesnt have to be.  In this article, were going to cover some best practices on how to host a successful holiday gathering with a loved one with Alzheimers or another form of dementia. INVOLVE YOUR LOVED ONEOne of the easiest ways you can bring your loved one joy during the holidays is to include them in your holiday preparations. This can mean allowing them to take a more active role in simple holiday preparations or having them observe your own. Think about what sorts of things your loved one enjoyed most about previous holidays and involve them where appropriate.Encouraging your loved one to take part in preparations can help get them into the holiday spirit and also make them more comfortable with what is happening on the day of the celebration.PLAN A SMALLER CELEBRATIONA loved one who has dementia can quickly become overwhelmed by large groups of people, especially those friends and family members who they may only see a few times a year. Whether youre planning a holiday celebration at a memory care residence or at home, youll want to keep the guest list to a minimum. Youll also want to keep your holiday celebration quiet and relaxed.One way to ensure your loved one gets to see everyone who is important to them is to arrange for family members to drop in on different days. Schedule visits at times when you know your loved one is typically in a good mood. Consider virtual visits where appropriate, as well.CREATE THE RIGHT ATMOSPHERECreating the right atmosphere is a large part of any successful holiday party. When youre celebrating the holidays with a loved one who has dementia the atmosphere can still be festive. You just need to keep your loved ones comfort in mind while you do your planning.Here are some tips to help you set the right mood for a loved one with dementia.Celebrate in a familiar setting. A sudden change in environment may cause distress for a loved one who has dementia. Consider bringing the party to them.Prepare quiet distractions to have ready if your loved one becomes overwhelmed. Even something simple, like going for a walk, can help your loved one feel more comfortable.Avoid excessive noise, including loud conversations or loud music. Make sure there is a quiet space where your loved one can rest and recharge as needed.Avoid lighting that is too bright or too dark. Blinking or twinkling lights can also be disorienting for someone who has dementia. Non-blinking lights are best.Instead of elaborate decorations, choose a few meaningful items.Creating the right atmosphere will vary from person-to-person. Keep in mind what types of things typically cause stress or bring your loved one joy. Know this may change as time goes on.ADAPT HOLIDAY ACTIVITIESWhen planning holiday activities for a loved one with dementia, its better to focus on a smaller number of meaningful activities they will enjoy. Someone who loves cooking may find joy in helping prepare the holiday meal. Others may simply appreciate observing activities.Consider setting an agenda for activities ahead of time and sending it out to your guests. This will help everyone know what to expect and if they need to bring anything with them. Getting your guests all on the same page ensures a better holiday experience for everyone involved.TAKE TIME TO ENJOY THE EXPERIENCEHoliday celebrations, while fun, can be stressful for the person planning them. But the additional effort you put into accommodating the needs of someone you care about allows you to reflect on what is most important in life and filter out the noise and clutter.Know that things may not go as planned. Remain positive and stay flexible. When youre celebrating the holiday with your loved one, give yourself time to enjoy the experience.CELEBRATE THE HOLIDAYS AT FRIENDSHIP VILLAGEAt Friendship Village of South Hills, a senior living community in Upper St. Clair, Pennsylvania, we work with our memory care residents and their families to help them celebrate the holidays in a way that is joyful for everyone.Whether you are looking for a private space to hold a small gathering of family and friends or simply want to have a holiday celebration in your loved ones suite, our team members will work with you to help identify the right holiday setup and accommodations for your loved one.This article was written by Friendship Village of South Hills.

Alzheimer's is a progressive and irreversible brain disorder that affects millions of people worldwide. It is a devastating disease that can have a profound impact on the individual living with it, as well as their family members and caregivers. Assisted Living Locators of North Pittsburgh is a valuable resource for families who are struggling to care for a loved one with Alzheimer's. Here's how they can help:1. Personalized AssistanceAssisted Living Locators of North Pittsburgh provides personalized assistance to families who are searching for the right assisted living facility for their loved one with Alzheimer's. They take into account the unique needs and preferences of each individual and their family, helping to ensure that they find a facility that is the right fit.2. Expert GuidanceAssisted Living Locators of North Pittsburgh has a team of experienced professionals who are knowledgeable about Alzheimer's and the various treatment options available. They can provide guidance and support to families throughout the process of selecting an assisted living facility, including information on specialized care for individuals with Alzheimer's.3. Access to a Network of Assisted Living FacilitiesAssisted Living Locators of North Pittsburgh has access to a network of assisted living facilities throughout the area, including those that specialize in caring for individuals with Alzheimer's. They can help families narrow down their options and find a facility that provides the appropriate level of care and support.4. Assistance with the MoveMoving a loved one with Alzheimer's into an assisted living facility can be a complex and emotional process. Assisted Living Locators of North Pittsburgh can help families with all aspects of the move, including downsizing, packing, and coordinating with the facility.5. Ongoing SupportAssisted Living Locators of North Pittsburgh provides ongoing support to families even after their loved one has moved into an assisted living facility. They can help families navigate any issues that may arise, such as changes in care needs or communication with the facility.In conclusion, Assisted Living Locators of North Pittsburgh is an invaluable resource for families who are caring for a loved one with Alzheimer's. They provide personalized assistance, expert guidance, access to a network of assisted living facilities, assistance with the move, and ongoing support. Their services can help alleviate the stress and anxiety that families often experience when caring for a loved one with Alzheimer's, and ensure that their loved one receives the best possible care. Save the date for Team Assisted Living Locators North Pittsburgh Alzheimer's Walk in Pittsburgh October 14, 2023.