Elder Law

• The Caregiving Component.  Check if care is on-campus or off-campus.  Also, if your family has a history of a medical problem, like Alzheimer’s, make sure your CCRC has good care for that.
• The Costs.  CCRCs normally have an entrance fee depending on the apartment size and a monthly fee to cover needs.  They are also dependent on other factors, including health, the number of residents living in the facility and the type of service contract (fee-for-service or all included).  Remember that many current expenses, like groceries and home maintenance, will be covered at the CCRC.  A general suggestion is to have your monthly income be one and a half times the monthly fee.
• The CCRCs Finances.  If the occupancy rate is below average (90%), the number could reflect poor management.  Also, look at the sponsoring companies and the CCRC’s track record.  Have a lawyer or geriatric care manager check the community’s status, too.  Make sure your CCRC can keep any promises they make.

While most older adults live on fixed income, they generally find that their property taxes or rent keeps increasing.  Fortunately, Pennsylvania has a program that can help offset these expenses.  The Pennsylvania Department of Revenue's Property Tax/Rent Rebate Program aims to help reduce the expenses that those living on fixed incomes cannot afford.  Those who are 65 years of age or older, as well as widows/widowers age 50 or older and disabled individuals 18 and older, may qualify for a property tax rebate, but only if they earn up to $35,000 a year.  Please note that this amount is excluding half of their Social Security income.  Renters are able to receive a rebate check if they earn up to $15,000 a year, again excluding half of their Social Security income.

The deadline to apply to this program is June 30, as checks will be issued beginning July 1.  If you need an application, you should call the Revenue Department at 1-888-222-9190 or go to www.revenue.state.pa.us.  Applications can be downloaded at this website.  If you need help completing the application, please call the Lancaster County Office of Aging at 717-299-7979.

Guess what, we all have a 100% chance of dying.  It's not the most pleasant topic, but it's bound to happen at some point.  Now, what about become disabled, what's the probability of that?  At the age of 25, a person has an 18 percent chance of being disabled.  Those over 85 have a 50% chance of having some type of dementia.  What happens if you become disabled?  Will your loved ones be left in the dark, without critical information that they don't know but should have?

That's where the idea of a Death/Disability Book comes into play.  We originally read about it in an article in the Pittsburgh Post Gazette and thought that it was worthy of sharing.  So grab yourself a colorful 2 inch and start looking for the following information to include!

Emergency Information

• Emergency Contacts - whoever you want to be contacted in case of an emergency.  Their names, addresses, phone numbers and email addresses.  You can also list your professional advisors hear (financial planner, accountant, lawyer, etc).
• Health Information - your healthcare providers, copies of health insurance information and cards, all your medications, your medical history

Estate Information

• Will - the original will is the most important document to keep on hand because it dictates how your assets will be distributed.  If your family can't find the original document, your assets may not go where you want them.
• Healthcare and Financial Power of Attorney - these documents give someone else (your agents) permission to make healthcare and money decisions for you should you become incapacitated.
• Trust Documents - if you set up a trust, these must be included.
• Funeral Arrangements - have you made them?  It makes it a lot easier on your family members if it's done in advance, just make sure they know where to find the relevant information to carry out your wishes.
• A letter of instruction - while not vital, if you have any other requests or other information that family members should know, you can write a letter telling them

Financial Information

• Taxes - do you keep a copy of last years' tax returns?  Show where these are located to make it easier to reconstruct your financial affairs.
• Insurance Policies - a summary list of all your policies, including auto, disability, homeowners, umbrella coverage, life, and long-term care.  Include the name of the carrier and contact information for the agents.
• Bank Information - again, have a summary of all of your accounts, with the institutions, types of accounts, account numbers, owners, safe deposit box numbers and keys included
• Credit Cards - note the account numbers and providers.  You can also include any membership cards to a specific store.
• Stock and Bonds - these are important assets even if they seem small!

Miscellaneous Items

• Other documents - you should consider including copies of your marriage license, birth certificate, passport, and social security card
• Passwords - a list of passwords and their corresponding accounts is crucial, especially in today's age with accounts for everything and a variety of requirements for the passwords
• Personal Effects - do you have any collectible items?  Put a list of them in this binder.  If you want, you can even include pictures of them, either in the binder or in another place that someone knows about.
• Anything else - this is your binder, include in it anything else you might think is necessary!!

Once you've created this binder, make sure a trusted individual knows where it is.  And while it does seem to be a daunting task,  imagine what the job would be like if someone else had to find all this information.  As with any major project, take it in bits and pieces over a defined period of time to lighten the load.  Anything you do, even if it isn't as exhaustive as this, will be helpful.  And your family will be eternally grateful for all the help you've given them.

In light of the recent tragedy at Sandy Hook Elementary, people are done blaming guns and starting to talk about mental illness.  As Liza Long points out in her article that went viral, "I am Adam Lanza's Mother" (read it here), that there are very few options for people with mental illnesses.  In fact, the only option they really have is to go to prison for people to start paying attention.

This lack of options, some people say, is because of government programs, like Medicaid (known as Medical Assistance in Pennsylvania).  But services for the non-poor mentally ill patients have been hit hard by the recession, and after the Supreme Court struck the mandate requiring states to expand Medicaid programs, people are worried that the Medicaid system will suffer further cuts.  These cuts cause a decrease in coverage or providers and longer waits for appointments, which in turn causes patients to be less likely to seek the help they need.

However, in light of recent events, lawmakers are making mental health services a priority to stop future tragedies.  We have to discuss the mental health aspect and find ways to provide care for the mentally unhealthy.  We can only hope that the Medical Assistance will work to cover the mentally ill, giving them options so prison is not the solution of choice and to keep everyone safe.

According to the Insurance Institute for Highway Safety, drivers over the age of 80 have the highest rate of fatal car crashes per mile, higher than even the teenage age group.  Vision problems, slower reactions and other effects of aging increase the risk of crashes and make it unsafe for many people to continue driving.  Additionally, most state legislature doesn't acknowledge the problem.  In Pennsylvania, licenses have to be renewed after 4 years instead of 8, but the renewal may be made via mail or internet instead of in person and requires no written test, eye exam, or on the road test.

Driving represents independence and freedom for many seniors, as well as providing them with mobility, so many politicians are hesitant to make the renewal process more stringent.  Since lawmakers tend to sidestep the issue, it's often up to families to take action when their loved one is no longer a safe driver.

If you suspect their driving skills are starting to falter, take a ride with your loved one, noting if he or she has trouble following traffic signals, maneuvering the car, remembering the route, or judging gaps in traffic.  If there is a problem, address it head on instead of waiting until after an accident and it is too late.  Here are a few simple tips on how to approach the subject:

• Chose the most appropriate person to first bring up the matter with your loved one.
• Unless it is clear the driver is unsafe all the time, try limiting driving instead of prohibiting it.  For example, suggest driving only during the daytime and staying off highways.
• Investigate alternative transportation options and their costs.  You can calculate how much money your family member would save by driving less or not at all and point out that these savings can be used for other modes of transportation.
• If an aging loved one resists giving up driving, let the physician or department of motor vehicles be the bad guys.
• If all else fails, you may be able to gain guardianship over your parent and get a court order to prevent him or her from driving.  You could also hide the car keys or disable the car, but some families find this option to backfire.

For more information on safe senior driving, visit http://seniordriving.aaa.com/.

Pennsylvania recently passed the Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act (UAGPPJA).  Although it doesn't have the shortest name, this law solves a relatively simple problem commonly known as Granny Snatching.  It addresses the issue of jurisdiction over adult guardianship (sometimes called conservatorship) by providing a mechanism for resolving multi-state disputes.  Ideally, the goal of the Adult Guardianship Act is to grant only one state jurisdiction at any one time.

Before this act, there were frequently cases of disputed guardianship.  Take the case of Loyce Juanita Parker (2008).  She was a lifelong resident of Oklahoma, but moved to Texas temporarily to be near her daughter while awaiting an opening for assisted living in Oklahoma.  Her daughter applied for guardianship in Texas, but her son applied in Oklahoma.  The case took much time and expensive litigation before it was finally ruled that the Oklahoma Court had jurisdiction.

Guardianships involve the appointment of someone or some entity to make decisions for an incapacitated person.  This differs slightly from a power of attorney, in that the incapacitated person does not need to give approval prior to the appointment.  A power of attorney grants the authority to act on behalf of the person with that person's approval.

Because the process for granting guardianship occurs in a state court, the United States has over 50 different systems.  Additionally, few states have streamlined procedures for transferring a proceeding to another state or for accepting this type of transfer.  This means that even without a dispute, there could be jurisdiction problems should the person move from one state to another.  Further problems arise because not all states recognize jurisdiction in other states, so being a Guardian in Pennsylvania may not give you access to assets in Nebraska.  By adopting a uniform set of laws, both the Pennsylvania and Nebraska courts could have communicated with one another and all problems would have been avoided.

Through the UAGPPJA, the above problems are eliminated. UAGPPJA establishes a uniform set of rules for determining jurisdiction, simplifying multi-state jurisdiction disputes.  It also establishes a framework that allows state court judges in different states to communicate with each other.  The law goes into effect on September 5, 2012 in Pennsylvania, saving guardians both time and money and allowing them to focus on the care of their loved one.

For more information, check out these resources below:

Adult Guardianship Jurisdiction Fact Sheet from the Alzheimer's Association

Adult Guardianship and Protective Proceedings Jurisdiction Act page from the Uniform Law Commission

Pennsylvania House Bill No. 1720

Being the caregiver of an elderly parent can be a tiresome job by itself.  If you have kids to worry about, it becomes that much more difficult.  While worrying about getting your mother to her doctor appointments, giving her her medications on schedule, making sure her kitchen is stocked if she's still living at home, etc, you have to make dinner for your kids, drive them to soccer practice, and make sure they get their homework done.  In a 1990 article, Newsweek reported that the average American woman will spend 17 years raising her kids and 18 years helping her aging parents or in-laws.

Family caregivers worry about spreading themselves too thin and their own ability to cope with all the responsibilities that face them.  So how can a family caregiver handle caring for their parents and their kids?  Here are some tips that might help you feel a little less sandwiched:

• Hold a family meeting.  Family meetings are a time to discuss conflicts and propose solutions together.  They allow everyone to contribute their thoughts and may encourage feelings to be shared that would otherwise go unspoken.  If family meetings seem to go nowhere, bring in a friend or other family member to moderate.
• Educate teens about their grandparent's condition.  Talking to them honestly about their grandparent's situation, both abilities and disabilities, can help kids, especially teens, better cope.  Illness can be scary, and some, like Alzheimer's, can impact them as well.  Kids will be better able to cope if they understand the nature of the illness and how it should progress.
• Ensure that family members have their privacy.  This is especially important for teenagers, so if your mom or dad moves in with you, give them their own space.  Ideally they should have their own room as well as a TV, phone or computer.  And make sure that your parent knows that the kids need their space and alone-time as well.
• Expect your kids' help, but be realistic about what they can do.  Kids should understand that they are a part of the family and will be depended on to help.  Prepare a list of all the things you do on a daily and weekly basis, then ask them which of those things they can do for you.  And most importantly, hold them to it!
• Don't ignore the quiet ones.  Some kids are louder than others, but that doesn't mean that the quiet ones aren't struggling.  They may just not want to further stress you out with complaints or don't know how to express their feelings.  Regularly ask your kids how they are feeling and acknowledge that this is a difficult situation for everyone.
• Focus on your marriage.  Set aside time each week for your spouse to do something you both enjoy.  Also, talk about the situation and don't let your marriage suffer because of it.  Your spouse can provide the comfort you need, and you want to nurture that relationship.
• Prepare a long-range financial plan.  Do you have kids heading to college soon?  How are you going to fund your parent's long-term care?  These are questions that you should be asking yourself to better prepare for the future.  A professional financial planner can help you figure out your parents' assets and how to use them to finance their care.
• Look for the blessings.  It may seem stressful to care for an elderly parent, but it can be very rewarding, too.  Many caregivers report great satisfaction due to the closeness they achieve with their parent.  This can also be a great experience for kids as they learn to sacrifice their own needs for the family.

Whether you have hours, weeks, or months to find a nursing home for an elderly loved one, the task is going to be daunting.  But this will be the task for a majority of the population, as two-thirds of people over 65 will need the care given by a nursing home, according to AARP.  Just as you wouldn't move into a new house without visiting and inspecting it, you should do research on nursing facilities ahead of time if possible.  And when researching, there are several key considerations you should take.

First, look at the official stats.  Medicare rates and compares nursing homes on their website (medicare.gov/nhcompare).  Some facilities are even certified by Medicare, meaning they are inspected every year and all complaints are investigated.  Read these ratings and recent inspection reports, but don't just take them at face value.  Check out the ratings for health inspections and for staffing and see if you can find why they rank as they do.  What are the citations for and how often do they occur?  One patient accident isn't a big deal, but frequent falls could be a red flag.  If you want more opinions on the nursing home, your local Area Agency on Aging (the Lancaster County Office of Aging) or a hospital discharge planner can give you referrals on nursing homes.  Furthermore, the state's ombudsman and licensing agency should be able to tell you about consumer complaints.

Check to see how staffing is at the nursing home.  How much time are residents receiving with the nurses?  The Centers for Medicare and Medicaid Services (CMS) recommends at least 2.8 hours a day of nursing aide time and 1.3 hours with an RN or licensed practical nurse.  Ask specific questions of the staff and about care, ask how personal preferences are accommodated.  Also see whether staff work with the same patients each day because when staffers know the patients better, the quality of care is higher.  Finally, make sure to ask how the staff will deal with an unexpected event, like a power loss or a situation which requires evacuation.

Visit the nursing homes you are considering, and visit more than once.  Observe lifestyle details, like do the nurses greet patients in the hall?  Are meal eaten in the dining room and are residents enjoying the meal?  Does it smell pleasant and homey and are residents smiling?  Check rooms for cheerfulness and safety, use the bathroom to check for hot water, and inspect the kitchen for cleanliness.   Ask about anything that could affect the well being and happiness of your loved one, like are there organized outings and visits?  What activities are listed on the bulletin board?  Are there stimulating offerings like exercise classes and a library?  Snoop around (and be wary of any place that objects) and try visiting unannounced on a weekend when staffing is likely to be tighter.

Another important consideration is how close the nursing home is to you.  The biggest influence on care quality is the frequency of visits by friends and family.  Make sure you're allowed to visit when you want to fit your schedule, and to monitor care at different times.  Drop by often and sometimes without notice.  Stay late sometimes after your loved one has fallen asleep.  By coming at different times, you can see how quickly a staff member respondes to a ring for assistance, whether residents are enjoying interesting activities together in the afternoon or staying cooped up in their rooms and how much your mom or dad eats at meals.

One of the biggest factors in your decision will be cost.  The median annual rate for a semi-private room in Pennsylvania last year was $89,425.  If the move is years away, consider getting long-term care insurance.  If your loved one already has long term care insurance, find out the daily rate it covers.  This could be far less than your preferred homes and most policies don't kick in until after a 60 or 90 day "elimination period."  To keep costs down, determine if it's possible to keep your loved one at home a bit longer through a combination of health aides, adult day care, and family help.  You can also consult an elder law attorney for help with nursing home planning.  The Law Office of Shawn Pierson can help with the planning and can help get you qualified for Medicaid, known as Medical Assistance in Pennsylvania.  However, not all facilities accept Medical Assistance, so make sure your preferred facilities accept payment or else you might have to move when payments switch.

If you find that your loved one is not receiving the care he or she deserves, don't hesitate to move him or her.

For more ideas on what to look for in a nursing home or long term care facility, use the checklist found here by AARP.

In our latest e-newsletter, there was an article titled "Son Liable for Mom's $93,000 Nursing Home Bill Under 'Filial Responsibility' Law."  The same day our newsletter went out, local attorney Patti Spencer had an article in the Lancaster newspaper regarding the same topic, that a son was responsible for his mother's nursing home bill.  Because of these, we've had some questions regarding filial responsibility, namely what is it and what does it mean?  Well, here's a quick run down on what Pennsylvania's filial responsibility law entails.

Pennsylvania, as well as 29 other states, has a filial responsibility law.  Although these laws vary from state to state, they all say generally the same thing; they require adult children to provide financial support for their indigent or poor parents.  In Pennsylvania, not only do the children have the responsibility of maintaining their mother or father, but the spouse of and the parents of the indigent person hold the responsibility as well.  Caring for a person also includes financially assisting him or her, however there is an exception in the case that an individual does not have the ability to support the person financially.  Additionally, A child shall not be liable for the support of “a parent who abandoned the child and persisted in the abandonment for a period of ten years during the child's minority,” meaning a child who was abandoned for 10 years while under the age of 18 is not responsible for his or her parents' care.

In order for the filial responsibility law to be enforced, a civil lawsuit must be filed to get court-ordered judgment. The amount of the liability will then be determined by the judgment from the lawsuit.  Civil action may be taken by the indigent person or any other person, public body or agency who has interest in the care and well-being of the indigent person.  Most commonly, it is the nursing home who takes civil action.

If you are found liable and fail to comply with the order, the court will schedule a contempt hearing.  If the court determines that the individual found liable has intentionally failed to comply with the order, that individual could face 6 months of jail time.

In the past 30 years, there have been only 3 cases discussing the filial responsibility law.  However, in wake of the recession and budget woes affecting state-funded nursing home programs, nursing homes and other care facilities may turn to filial law to recover the lost funding.  You can protect yourself and your parents now through estate planning, long-term care insurance and knowing home Medical Assistance works.  Legal action for filial responsibility isn't all that common now, but the trend may change.  If you are at all concerned about this, or have more questions, call our office at (717) 560-4966 or email us at questions@piersonelderlaw.com and we will be more than happy to help.

Want to read more?  You can find our newsletter article here or the article by Patti Spencer here.  Additionally, to read the current Pennsylvania statute on filial responsibility, click here.

The current age for Medicare eligibility is 65 and has been 65 ever since the program was created.  However, there are currently debates over raising it in two month increments each year until 2027, when the eligibility age will reach 67.  According to a report released by the Congressional Budget Office (which can be found here) this would reduce the federal budget deficit by $148 billion over the next 10 years.  Compared to the $15 trillion of government debt, it's not a whole lot, but it is definitely quite a bit of money.

However, the cost for the 65- and 66-year-olds, their employers, and the states would be $220 billion, quite a bit more than the savings by the government.  Additionally, an estimated 25% of 65- and 66-year-olds would find themselves uninsured.  So is this really a good idea?

There are arguments for both sides.  As seen, the total costs in the long run would be higher, but it would lower the federal budget deficit, which at $15 trillion needs to happen.  It could also encourage more people to work and to keep their job until they're older so that they still have health insurance, however the CBO expects this effect to be small.  Still, this can contribute to a more thriving economy, but would also give college graduates a harder time finding a job as people are taking longer to retire and less replacements are needed in the work force.  Medicare premiums might go up because the program would lose its healthiest beneficiares (the 65- and 66-year-olds) and private insurers would suddenly be getting more older beneficiaries, increasing their premiums as well.  And not everyone would be able to turn to private insurance; an estimated 5 percent would become uninsured.

There are obviously other effects and considerations as well, including changing the early eligibility age and the full retirment age.  I really recommend that you read the full report from the Congressional Budget Office yourself as it includes a lot of good information as well as different scenarios.  I do, however, leave you with this thought, should we decrease the federal budget deficit or should we guarantee that our 65- and 66-year-olds are insured?  Both decisions affect our future.