Category: Aging Parents (Page 9 of 9)

Why Aren’t More Women Working? They’re Caring for Parents

September 5, 2019 / drussellcfp

A recent New York Times article profiles the lives of women who have no other option than to drop out of the work-force to care for an aging parent, at significant cost to the economy.

The burden of care for aging relatives is reshaping the lives of millions of others. About 15 percent of women and 13 percent of men 25 to 54 years old spend time caring for an older relative, according to the Labor Department. Among those 55 to 64, the share rises to one in five Americans. And 20 percent of these caregivers also have children at home.

Nursing Home Staffing Reports for all 50 States

August 29, 2019 / drussellcfp

The Long Term Care Community Coalition (LTCCC) is a nonprofit organization dedicated to improving quality of care, quality of life and dignity for elderly and disabled people in nursing homes, assisted living and other residential settings.

LTCCC focuses on systemic advocacy, researching national and state policies, laws and regulations in order to identify relevant issues and develop meaningful recommendations to improve quality, efficiency and accountability. In addition to providing a foundation for advocacy, LTCCC uses this research and the resulting recommendations to educate policymakers, consumers and the general public. Consumer, family and LTC Ombudsman empowerment are fundamental to our mission.

LTCCC’s work is grounded in its organization as a New York State based coalition of consumer, community, civic and professional organizations, bringing together these different stakeholders to identify & address the systemic issues that affect quality of care and dignity in long-term care.

Click on the links below to download easy-to-use files for each state. Each file includes information on: Each facility’s direct care RN, LPN, and CNA staffing levels; Staffing levels for important non-nursing staff, including administrators and activities staff; and The extent to which the facility relies on contract workers to provide resident care.To facilitate

Source: Nursing Home Staffing 2019 Q1 – Nursing Home 411

Caregiver Burnout

August 28, 2019 / drussellcfp

What is caregiver burnout?

Caregiver burnout is a state of physical, emotional and mental exhaustion. It may be accompanied by a change in attitude, from positive and caring to negative and unconcerned. Burnout can occur when caregivers don’t get the help they need, or if they try to do more than they are able, physically or financially. Many caregivers also feel guilty if they spend time on themselves rather than on their ill or elderly loved ones. Caregivers who are “burned out” may experience fatigue, stress, anxiety and depression.

What causes caregiver burnout?

Caregivers often are so busy caring for others that they tend to neglect their own emotional, physical and spiritual health. The demands on a caregiver’s body, mind and emotions can easily seem overwhelming, leading to fatigue, hopelessness and ultimately burnout. Other factors that can lead to caregiver burnout include:

Role confusion: Many people are confused when thrust into the role of caregiver. It can be difficult for a person to separate her role as caregiver from her role as spouse, lover, child, friend or another close relationship.
Unrealistic expectations: Many caregivers expect their involvement to have a positive effect on the health and happiness of the patient. This may be unrealistic for patients suffering from a progressive disease, such as Parkinson’s or Alzheimer’s.
Lack of control: Many caregivers become frustrated by a lack of money, resources and skills to effectively plan, manage and organize their loved one’s care.
Unreasonable demands: Some caregivers place unreasonable burdens upon themselves, in part because they see providing care as their exclusive responsibility. Some family members such as siblings, adult children or the patient himself/herself may place unreasonable demands on the caregiver. They also may disregard their own responsibilities and place burdens on the person identified as primary caregiver.
Other factors: Many caregivers cannot recognize when they are suffering burnout and eventually get to the point where they cannot function effectively. They may even become sick themselves.

What are the symptoms of caregiver burnout?

The symptoms of caregiver burnout are similar to the symptoms of stress and depression. They include:

Withdrawal from friends, family and other loved ones
Loss of interest in activities previously enjoyed
Feeling blue, irritable, hopeless and helpless
Changes in appetite, weight or both
Changes in sleep patterns
Getting sick more often
Feelings of wanting to hurt yourself or the person for whom you are caring
Emotional and physical exhaustion
Irritability

Source: Caregiver Burnout | Cleveland Clinic

Undocumented Caregiving results in Medicaid Penalty Period

August 26, 2019 / drussellcfp

In a case that stresses the importance of keeping accurate records, especially for paid family caregivers, a New Jersey appeals court upheld a penalty period imposed by Medicaid against a Medicaid applicant for payments the applicant’s daughter received for providing caregiving service. E.B. v. Division of Medical Assistance and Health Services (N.J. Super. Ct., App. Div., No. A-3087-15T4, July 13, 2018).

The daughter [J.W.] testified that, in 2003, her then eighty-year old mother moved into her home. There was an area of J.W.’s home which, although physically attached to the house, was a separate unit where her mother lived. Her mother moved into the apartment because she was afraid of living by herself and was unable to shop or cook for herself.

In 2009, J.W. resigned from her job in order to care for her mother full time. In addition to providing supervision, J.W. assisted her mother with the activities of daily living. In 2011, J.W. was finding it too difficult to make ends meet because she was not earning income. She determined she either had to return to work and let a third party care for her mother during the day, or pay herself from her mother’s savings to compensate her for providing companion services. She chose the latter solution.

After some adjustments, Medicaid determined that $69,211.90 paid from the mother’s funds in order to pay for companion services was not for fair value, and imposed a penalty period. [Normally, the length of the penalty period is determined by the disallowed transfer – $69,211.90 – divided by the average monthly cost of nursing case in the area in which the applicant lives. For example, if the average cost of care in her area was $6,000 per month, then the penalty period would last for roughly one year.]

In making its determination, Medicaid found that the “proof of services rendered on a daily basis to the petitioner deficient”. There were no log sheets or like records tracking the hours she worked and the duties she performed. Second, it found the hourly rate paid to J.W. was not substantiated as appropriate for companion services. Third, J.W. began receiving wages when it was “foreseeable that advanced age and deteriorating condition would require intensive care and the possibility of entering a nursing care facility.” Finally, he observed there was no pre-existing written agreement between the mother and J.W. to pay for the subject services.

In denying her appeal, the Superior Court of Appeals in New Jersey stated:

We understand J.W.’s reasoning, specifically, that if she had to return to work, petitioner may as well pay her rather than a third party to provide companion services, especially because J.W. is a family member and would have her best interests in mind. Nevertheless, “a transfer of assets to a friend or relative for the alleged purpose of compensating for care or services provided free in the past shall be presumed to have been transferred for no compensation.” N.J.A.C. 10:71- 4.10(b)(6)ii.

Family caregivers should take note and adopt written care agreements, and keep time and task logs to guard against similar penalty impositions. Above all, seek the advice of a qualified Medicaid attorney in the state the applicant lives in to help navigate the complex process of applying for Medicaid.

For the full text of this decision, go to: https://www.judiciary.state.nj.us/attorneys/assets/opinions/appellate/unpublished/a3087-15.pdf?cacheID=TSSOcTe

Are you liable for your parent’s nursing home bills?

August 20, 2019 / drussellcfp

Unbeknownst to most Americans, more than half of U.S. states (29 plus Puerto Rico) have “filial responsibility” laws in effect that could potentially obligate adult children to support their impoverished parents. That includes paying the tab for basic necessities like food, housing, clothing, and medical attention, according to Little.

Source: Are you liable for your parent’s nursing home bills? | MassMutual

Turns out however that even states with such laws rarely enforce them, mainly because they weren’t needed after Medicaid became available, but also because federal laws enacted in 2016 prohibit nursing homes from requiring payment from third parties. In most states, for a child to be held accountable for a parent’s bill, all of these things would have to be true:

The parent received care in a state that has a filial responsibility law.
The parent did not qualify for Medicaid when receiving care.
The parent does not have the money to pay the bill.
The child has the money to pay the bill.
The caregiver chooses to sue the child.

Nevertheless, as the cost of long term care stresses the funding limits of Medicaid, and with Medicaid planning used as an asset preservation strategy of those with significant assets, don’t be surprised if public opinion influences legislation that shifts more of the cost burden on the family and away from the government.

One Family’s Journey Through Guardianship Hell

August 5, 2019 / drussellcfp

In one of the saddest yet too-common stories about what happens when families fail to plan, this post from investigative journalist, Gary Weiss, for NextAvenue.org outlines five mistakes that one family made on their journey through guardianship hell.

“You sit there and shake your head how things can go that bad that fast,” says Frederick Paugh, a field investigator with the New Jersey Long Term Care Ombudsman who examined some of the financial aspects of the case at the request of Ada’s assisted living facility. “ But you know what? It happens.”

What ended as a descent into legal hell began in Italy as a love story. Read the rest of the story here.

Source: One Family’s Journey Through Guardianship Hell

What are the “Four-P’s” of Financial Caregiving?

August 1, 2019 / drussellcfp

If you are one of the millions of those who identify themselves as part of the “Sandwich Generation” then you may be largely responsible for the financial decisions and well-being of an aging parent or loved one. Most will be thrust into the role largely unprepared and learn through on-the-job training. The problem with this approach is that the job is not an internship where an entire team of superiors form a safety net around your inevitable mistakes. Furthermore, the financial decision-making responsibilities are often added to the even greater stress of providing emotional or physical caregiving. Caregiver Burnout is a serious modern condition suffered by millions who are providing a sometimes overwhelming level of care.

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Like every aspect of caregiving, the motivation behind financial caregiving has to be one of love, honor, and respect for the one for whom we are providing care. To do the job effectively means that we need to educate ourselves. That’s what motivated me to write the book, What You Need to Know, back in 2012. I thought I knew all there was to know about financial caregiving until I became one. I was a professional financial planner after all. I had worked with clients for over thirty years helping them prepare for financial independence.

But in spite of all this preparation, and even with a healthy investment portfolio, it soon became clear that my parents were going to need someone to get intimately involved with their finances. Someone was going to have to organize and take over the tax reporting, bill paying, income tracking, insurance renewals, Medicare supplement choices, Prescription Drug Plans, Social Security check deposits, phone service, internet service, online parts ordering, sale of the unnecessary second vehicle, getting new Wills done, making sure Powers of Attorney were in place, helping with physician choices, etc., etc., etc.

As order evolved from chaos, I began to organize what I needed to know around four major areas – what I later called “The Four P’s” that include the following:

People
Property
Programs
Plans

In subsequent posts, I’ll delve deeper into each of these areas to suggest what you need to know about each of these in order to be an effective and honoring financial caregiver.

How Much Do I Need to Know About My Parent’s Finances?

July 26, 2019 / drussellcfp

Few people want to stick their noses into their parents’ business. For many, it’s the last taboo to inquire into your parents’ financial lives. This is one of those “it depends” questions. It isn’t always necessary for you to know every detail about your parents’ financial affairs. In fact, the less you need to know, the more likely they may be to tell you what you should know.

If your parents are still in good health mentally and physically, and are managing their affairs with no need for assistance, then the amount of detail you need to know is limited. They may be reluctant to tell you how much they are worth, or to reveal the contents of their wills. That’s okay. In that case, let them know that your concern is to know where to find important records in the event something happens.

If one or both of your parents are beyond their 80’s or if they are showing some signs of needing assistance with financial matters, then you are going to need to know more than simply where things are. And if you are serving as a conservator, trustee, or exercising authority under a power of attorney, then you have truly become a financial caregiver and will need to know as much as possible about their arrangements.

I use the “Continuum of Dependence” graphic below to visually show how much information an adult child or other family member needs to be aware of depending on the level of dependency someone is experiencing.

How Much Do You Need to Know?

Seven Conversation Starters to Initiate Talks about Money with Your Parents

July 23, 2019 / drussellcfp

The question I am most often asked is “How do I begin the conversation with my parents?” I always answer, “Very carefully.” The truth is there is no one best way to begin the conversation. So much of it depends on circumstances and personality. Circumstances – usually health issues – may be at such a crisis point that you simply must take action with or without your parents’ approval – either by asserting your authority as attorney-in-fact under a valid Power of Attorney, or by seeking a court ordered guardianship or conservatorship. Your proximity to your parents, sibling agreement over what needs to be done (or the lack thereof), whether both parents are living, and the complexity of your parents’ financial affairs are just a few of the circumstances to consider. You also need to act quickly if you begin to notice impulsive spending or investment decisions.

Personality and family dynamics are also factors, and the relationship between child and parent doesn’t always make a lot of sense. Your eighty- eight year old father may still view you as the “baby” of the family even if you are sixty-two years old and have raised a family, managed a medical practice or a business of your own, and are practically retired yourself. You are the baby and you always will be. So before you begin the conversation in the first place, you might want to talk to a family counselor, their personal physician, or clergy member before you set yourself up for resentment. It’s okay if you are not the one to initiate the conversation.

Nevertheless, here are some ideas on getting the conversation rolling that you can try out.

The “I’ve got this friend” technique. This ice-breaker allows you to set up a hypothetical situation involving a real or fictitious friend who is wondering how to talk to their parents about money. It starts something like this: “Mom (Dad), I’ve got this friend who needs to ask her parents some personal questions about their finances, but isn’t sure how to ask. What should I tell her?” Chances are your folks will be on to this one soon after you ask it, and hopefully you can turn it into a good laugh by your honest confession that the “friend” is you. Once the chuckle is over, you can come back to it with a “Well…what would you say?” and just let them talk.
Ask how their friends are doing. Once your parents pass the age of seventy-five, chances are they will be attending more friends’ funerals or visiting more friends in nursing homes. You probably will have known these friends for a long time yourself, as well as the children of these friends. While remaining sensitive to the situation, use these events to ask how their friends are doing. Something like, “Mom, now that Jane is widowed, who is watching out for her?” Or “Dad, it’s sad to see your friend Sam lose his independence like that. Does he have children close by who can help with his business?”
Ask for help with your own finances. If your parents are past seventy, this means you’re probably past forty and are making some important financial decisions yourself. Asking for Dad’s advice on preparing your will or how to invest your retirement funds can go a long way to opening up a dialogue on his own business. Maybe your dad is fully capable of managing his finances now, but this conversation can ease the next one when the time comes for you to be a little more inquisitive.
Use the headlines. Unfortunately, the headlines can give you a lot of ammunition to use to open a conversation about your parents’ finances. All you have to do is google the phrase “financial abuse of elders” and you’ll be provided with dozens of sites and news articles about the vulnerability of seniors for financial scams and high-pressure sales tactics. Print out one of these articles, or clip one from your local newspaper and show it to them. Use an opener like, “I doubt this could ever happen to you, but…” Their response will tell you how open or closed they are to the subject.
Movies are great ice breakers. If your parents’ sight and hearing haven’t diminished, a good movie that deals with the subject of aging is a great ice breaker. One caveat, don’t use movies that are too dramatic or serious. Humorous movies are better at breaking down barriers to talking about this. Also, be sensitive to ratings that may not be comfortable for a generation that may see many of today’s PG-13 movies as too “racy”.
Try point blank honesty. If your parents are cut-to-the-chase kind of folks, then just try being upfront with them. “Mom and Dad, you’re both getting older and quite frankly, you’re not as sharp as you used to be. If something happens to either or both of you, I don’t know where to find your wills, or even where all your accounts are.” You may be surprised at how open they are willing to be if you show a compassionate yet firm resolve.
Ask about their advisors. If your parents use a financial advisor, ask for an introduction, or for permission to attend their next meeting with him or her. Sometimes advisors will be hesitant out of privacy concerns since they are bound to certain confidentiality standards. Getting written permission from your parents that the advisor is free to discuss their situation with you will generally alleviate these concerns.

However you begin the conversation and no matter the reception you get, the point is that the adult child is (and should be) the first line of defense for his or her parents just as they were (or should have been) your first line of defense growing up. Perhaps your past was more tumultuous, and perhaps your present is not conducive to you taking on the responsibility now. But you can be an advocate, and you can be involved to ensure that their financial affairs continue to provide security and dignity in their twilight years.