Category: Living Arrangements (Page 1 of 3)

Reader asks, “What’s the difference between ‘assisted living’ and ‘nursing home care?

October 1, 2024 / David Russell

My father is 89 and seems to be forgetting things like taking his medications and practicing good hygiene. Last week, while visiting him at his home, it was clear he hadn't bathed for several days and he looked unkempt. I've been looking into nursing homes in the area where I live, but a friend suggested I look into an assisted living facility instead. What are the differences and is one generally more expensive than another?

Stan B.

It’s understandable to feel apprehensive when you notice changes in a loved one’s well-being, especially in their later years. Aging brings a myriad of challenges, and your attentiveness to these issues is commendable.

Your father’s situation—forgetting about medications and neglecting personal hygiene—is not uncommon among seniors. It can be difficult for them to maintain independence while also ensuring their needs are met adequately. Given these circumstances, exploring options like nursing homes and assisted living facilities is a wise move.

Mom leaves more to one child than another: what could go wrong?

September 10, 2024 / David Russell

Three years ago, my mother moved in with me and I became her full time caregiver. Last year she changed her will to leave more to me than my sister who hasn't done anything for her care. In fact, she hasn't spoken to mom since she moved in with me. I don't get paid for providing care, but I do use her social security check to help pay for household bills and groceries. Aside from that, mom has a sizeable stock account that she inherited from our dad. I'm worried my sister may cause trouble when mom dies and learns she doesn't get as much as I do. Should I ask her to change her will to be more equal?

Esther B.

I can sense the unease in your voice. As caregiver for your mother, it makes sense that she might favor you in her will, especially if your sister isn’t interested in a relationship with your mom. While your question is more about what happens after your mother dies, my hope is that there will be opportunities to communicate with your sister before that happens, resolve the rift between her and your mother, and avoid the potential conflicts that may arise. Ultimately the decision to accept the provisions of your mother’s will is hers.

That said, let’s discuss some practical issues to address your concerns, minimize legal complications, and discourage potential disputes with your sister when it comes to your mother’s will.

Understanding the Legal Framework

First, it’s important to ensure that the change your mother made to her will is legally sound. The will must have been updated at a time when your mother was fully competent and free from undue influence. Consulting an estate attorney can ensure all legal protocols were followed, thus making it less vulnerable to future challenges.
Was the change made with the assistance of an attorney? Although it’s not a requirement, using an attorney to execute legal documents like wills can avoid the mistakes people make when doing it themselves. Often, people will write a will in their own handwriting (called a holographic will). While these may be valid, these types of wills are easily disputed and may not have followed the procedures for valid will executions in the state where the person resides.
Assuming your mother did use a lawyer, and at the time did possess the capacity to execute a new will, who was present in the room with your mother’s lawyer when she changed her will? Just your mother? You with your mother? Only you? Ideally, it was only your mother. If you were present, did the lawyer directly address your mother or direct questions to you? The less your involvement in the meeting, the less likely you could be open to accusations of undue influence.

Guarding Against Will Contests

If your sister decides to contest the will, she could potentially claim undue influence or argue that your mother lacked the mental capacity to make such a change. To prepare for such scenarios, work with her attorney to maintain thorough records of the discussions and motivations behind the will’s adjustments. This documentation reinforces that the decision was made independently and with full awareness.
Did your mother include a no-contest clause to her will? Known as an in terrorem clause, this can discourage your sister from contesting the will, as she risks forfeiting her inheritance if she loses the challenge. While this is not enforceable in every jurisdiction, where applicable, it serves as a strong preventive measure.
A letter of intent can also be included, detailing your mother’s reasoning behind her decisions. This document, although not legally binding, provides context that could be useful in defending the will against disputes. Sometimes, these are prepared by the person creating the will, but the attorney may also provide this service.
Keeping detailed records of your caregiving responsibilities and related expenses is crucial. Not only does it validate the more substantial inheritance in compensation for your caregiving role, but it also provides a clear, factual basis for the distribution decision should your sister challenge it.

Proactive Communication and Mediation

Facilitating open communication with your mother and sister could be beneficial. If your mother is comfortable, hosting a family discussion where she shares her reasons for the will’s changes may help your sister understand the context and reduce tension. Transparency often alleviates suspicions and pre-empts conflicts.

If direct communication seems difficult, consider bringing in a professional mediator. A neutral third party can help facilitate productive discussions and address any underlying concerns or grievances. This proactive step can prevent more heated disputes down the line.

Engaging a Professional Team

Engaging the right team is critical. Not only can a team of professionals provide advice and counsel, but their presence and involvement demonstrate that you are not acting alone in managing your mom’s affairs. If her lawyer does not specialize in estate planning or elder law, you can look for one near you by visiting the National Academy of Elder Law Attorneys. Other team members might include a geriatric care manager, financial planner, or family counselor.

By addressing these issues now—through open communication, legal safeguards, thorough documentation, and professional advice—you can reduce the likelihood of disputes and honor your mother’s wishes effectively. While it’s a challenging situation, approaching it with preparation and empathy can help maintain family harmony and respect for everyone involved.

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Ten Ways Technology Can Help with Remote Caregiving

August 20, 2024 / David Russell

I live far away from my older parents and I have no siblings. They insist on staying in their home as they age and I am concerned about their being alone. I work in the tech industry and would like to know what new technologies are useful to help families care for their aging loved ones?

Mark W.

This is such a common situation nowadays. As our parents grow older, their desire to remain in the comfort and familiarity of their own homes is completely understandable. For those of us living far away without siblings to share in the responsibility, ensuring their safety and well-being can be challenging. Fortunately, advancements in technology, alongside traditional forms of support, offer innovative solutions to make caring for aging loved ones manageable from afar. As someone working in the tech industry, you’ll find these developments particularly meaningful as they offer peace of mind while fostering closer connections despite physical distance

Smart Home Devices

Smart home technology has become indispensable for seniors wishing to age in place independently. Devices like smart speakers with voice-activated assistants (such as Amazon Echo or Google Home) enable seniors to set medication reminders, manage schedules, and control home appliances effortlessly. Additionally, smart security systems, like Ring doorbells, allow older adults to monitor visitors at their doorstep without having to physically open the door, enhancing both safety and convenience.

Personal Emergency Response Systems (PERS)

PERS have advanced beyond simple panic buttons. Current systems offer features like fall detection, GPS tracking, and two-way communication. Products such as MobileHelp and Philips Lifeline ensure that seniors can summon help at any moment, providing reassurance to both them and their distant caregivers.

Telehealth and Remote Monitoring

Innovations in healthcare technology have transformed access to medical care for seniors. Telehealth platforms facilitate virtual doctor visits, significantly reducing the need for travel. Additionally, remote monitoring tools track vital signs, including heart rate and blood pressure, sharing real-time health data with medical professionals to ensure timely care and intervention.

Robotics and AI

The rise of robotics and artificial intelligence in elder care is an exciting development. Companion robots like ElliQ by Intuition Robotics and Pepper by Softbank Robotics are designed to engage with seniors, offering companionship, reminders, and health monitoring. Furthermore, AI-driven tools can analyze behavioral patterns, identifying changes that may signal health concerns before they become serious issues.

Four Ways to Pay for Long Term Care with Home Equity

August 15, 2024 / David Russell

My wife and I are in our mid-seventies and concerned with how we will pay for care as we age. We do not have long term care insurance and likely could not qualify due to health reasons. We own our $700,000 home debt-free but have modest liquid assets. Can we use our home equity to pay for care without having to sell it or go into debt? We would like to stay in our home as long as possible.

Frank W

As we age, the need for long-term care becomes a critical consideration for many families. For older adults who have not purchased long-term care insurance or do not have sufficient liquid assets to cover extensive care costs, their primary asset—the family home—often becomes a focal point for financial planning. Many individuals feel that their home is the one asset they’ll be able to leave to family members. However, most polls show that children don’t really want mom and dad’s home. Inheriting the home also means inheriting taxes, maintenance, insurance, and squabbles over division. Most homes are sold at a discount with the cash divided among heirs.

It makes sense then that the home should be an available resource for long term care expenses. Your wishes to stay in your home as you age and move from independence to dependence is also typical. Most people would prefer to “age in place.”

Let’s look at four less-traditional ways to use your home equity to pay for long-term care.

Multi-Generational Living – It’s Complicated.

August 6, 2024 / David Russell

In recent years, a noticeable trend has emerged: Millennials are increasingly choosing to live with their Baby Boomer parents well into their 30s. This phenomenon is not merely a result of personal preference but is deeply intertwined with economic realities and changing societal norms. Moreover, it raises important questions about the willingness or reluctance of Millennials to provide care for their aging parents. Let’s delve into the economic and relationship aspects of multi-generational living, examining both its benefits and challenges.

Understanding the Trend

Several factors contribute to the rise of multi-generational living arrangements. Economic pressures, such as soaring housing costs and stagnant wages, make it difficult for young adults to afford independent living. According to a recent Pew Research Center report, more than a third of young adults aged 18 to 34 are living with their parents, the highest share in decades. This statistic underscores the economic strain facing Millennials and their need for alternative housing solutions.

Exploring Accessory Dwelling Units (ADUs): A Viable Housing Solution for Seniors

March 25, 2024 / drussellcfp

As the baby boomer generation continues to age, the demand for suitable housing options for seniors is on the rise. With an increasing number of seniors needing long-term care and assistance, the strain on traditional housing solutions such as senior living communities, continual care retirement communities (CCRs), assisted living facilities, and nursing homes is becoming more apparent. However, amidst this growing demand and shortage of appropriate housing, Accessory Dwelling Units (ADUs) emerge as a promising alternative that offers numerous advantages for seniors and their families.

The Demographic Realities: Baby Boomers and Long-Term Care

The baby boomer generation, born between 1946 and 1964, comprises a significant portion of the population in many countries. As this generation ages, the need for long-term care and housing solutions tailored to their needs is becoming increasingly urgent. According to demographic projections, the number of individuals aged 65 and older is expected to substantially increase over the coming decades, putting significant pressure on the long-term care industry.

Supply-Demand Mismatch in the Long-Term Care Industry

One of the critical challenges facing the long-term care industry is the growing gap between the demand for caregivers and the available supply of workers. As the aging population swells, the need for trained professionals to provide care and support to seniors also rises. However, the supply of qualified caregivers is struggling to keep pace with this demand, leading to concerns about the quality and availability of care for seniors.

In a little over a decade—by 2030—there is projected to be a national shortage of 3.8 million unpaid family caregivers and 151,000 paid care workers. By 2040, the shortfall is expected to grow to 11 million family caregivers and 355,000 paid workers.

National Academy of Social Insurance

Shortage of Housing Options

In addition to the labor shortage in the long-term care industry, there is also a shortage of suitable housing options for seniors. Traditional senior living facilities often have lengthy waiting lists, and the cost of admission can be prohibitive for many families. This shortage of housing exacerbates the challenges faced by seniors and their families in finding appropriate accommodations that meet their needs for safety, accessibility, and affordability.

The Rise of Accessory Dwelling Units (ADUs)

In this landscape of increasing demand and limited supply, Accessory Dwelling Units (ADUs) present a compelling solution for seniors seeking alternative housing options. ADUs, also known as granny flats, in-law suites, or secondary dwelling units, are self-contained living spaces that are either attached to or located on the same property as the primary residence. These units offer several advantages for seniors and their families:

Multigenerational Living: Adult children can build ADUs on their residential lots to provide housing for their aging parents. This arrangement allows seniors to maintain close familial ties while still enjoying a sense of independence and privacy.
Age in Place: Seniors can construct ADUs on their own properties, allowing them to age in place while receiving support from family members or paid caregivers. ADUs can be customized to accommodate the specific needs of seniors, including features such as grab bars, wheelchair ramps, and widened doorways for accessibility.
Affordability: Compared to traditional senior living communities or assisted living facilities, ADUs can be a more affordable housing option. They typically require less upfront investment and offer the potential for rental income if not occupied by family members, making them financially feasible for many seniors and their families.
Flexibility: ADUs are versatile living spaces that can serve multiple purposes over time. As seniors’ needs change, ADUs can be repurposed to accommodate caregivers, visiting family members, or even rented out to generate additional income.

ADUs Have Been Promoted by the US Dept. of Housing and Urban Development (HUD)

In June of 2008 during the midst of the housing crisis, the U.S. Department of Housing and Urban Development Office of Policy Development and Research published a research paper promoting ADUs as a solution to elder housing and to housing affordability in general. The research included case studies from several suburban cities that have included favorable ordinances supporting the use of ADUs while maintaining the integrity of the neighborhoods within the community. The research concludes, stating:

Communities find that allowing accessory dwelling units is advantageous in many ways. In addition to providing practical housing options for the elderly, disabled, empty nesters, and young workers, ADUs can provide additional rental income for homeowners. ADUs are smaller in size, do not require the extra expense of purchasing land, can be developed by converting existing structures, and do not require additional infrastructure. They are an inexpensive way for municipalities to increase their housing supply, while also increasing their property tax base. By providing affordable housing options for low- and moderate-income residents, communities can retain population groups that might otherwise be priced out of the housing market.

US Dept of Housing and Urban Development

Conclusion

In light of the demographic realities of an aging population, the supply-demand mismatch in the long-term care industry, and the shortage of suitable housing options for seniors, Accessory Dwelling Units (ADUs) emerge as a viable solution that addresses these challenges. By providing affordable, flexible, and age-in-place housing options, ADUs offer seniors the opportunity to maintain independence, receive necessary care and support, and remain connected to their families and communities. As policymakers, urban planners, and families grapple with the complexities of aging demographics, ADUs represent a promising pathway towards meeting the evolving needs of seniors in the 21st century.

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How to Have Difficult Conversations About Senior Living Options

July 21, 2023 / drussellcfp

As our parents age, there may come a time when we need to have challenging conversations about their future living arrangements. The topic of senior living options can be sensitive and emotional, but it’s essential to address it with empathy, understanding, and respect. In this guide, we’ll provide insights and strategies on how to approach these conversations effectively, ensuring that your loved ones’ wishes and needs are considered.

1. Choose the Right Time and Place: Initiating a conversation about senior living options requires careful consideration of timing and environment. Choose a comfortable and private setting, and make sure there are no distractions. Avoid discussing this topic during busy family gatherings or when emotions are running high. Opt for a time when everyone is relaxed and open to discussing the matter calmly.

2. Listen with Empathy: Approaching the conversation with empathy and active listening is crucial. Your parents may have a range of emotions and concerns about the idea of transitioning to senior living. Take the time to listen to their thoughts, fears, and desires. Acknowledge their feelings and validate their experiences to create a supportive atmosphere where they feel heard and understood.

3. Focus on Their Needs and Preferences: Every individual has unique needs and preferences when it comes to senior living arrangements. Some may prefer to stay in their homes with in-home care, while others might feel more comfortable in a retirement community or assisted living facility. Respect their autonomy and choices, and involve them in the decision-making process. Be open to exploring different options together, considering factors like proximity to family, medical care, and social activities.

4. Address Safety and Care Concerns: Safety and care are paramount considerations when discussing senior living options. Express your concern for their well-being and highlight how certain living arrangements can enhance their safety and provide access to essential support services. Share information about the benefits of professional caregivers and the sense of community they can experience in senior living communities.

5. Involve Other Family Members: If possible, involve other family members in the conversation to show a united front and demonstrate a shared commitment to your parents’ best interests. Discussing senior living options as a family can provide a broader perspective and may alleviate any feelings of isolation or pressure on your parents.

6. Provide Information and Support: Share educational resources and information about different senior living options to help your parents make informed decisions. Provide brochures, online resources, or arrange visits to local retirement communities or assisted living facilities. Offering emotional support throughout the decision-making process can help alleviate anxiety and stress.

Discussing senior living options with aging parents can be challenging, but it’s essential to approach these conversations with compassion, active listening, and respect for their autonomy. By choosing the right time and place, focusing on their needs and preferences, and involving other family members, we can navigate this sensitive topic together, ensuring our loved ones receive the care and support they deserve in their later years.

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Nursing Home’s Arbitration Agreement Found ‘Unconscionable’

August 19, 2022 / drussellcfp

In 2021, The 8th U.S. Circuit Court of Appeals gave the green light to a federal regulation that allows nursing homes to use arbitration agreements with residents, but prevents them from making the agreements a prerequisite for admission. Several nursing homes had filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS) challenging the new regulation. However, the court upheld the regulation, stating in its opinion that,

“In our view, it is reasonable for CMS to conclude that regulating the use of arbitration agreements in LTC facilities furthers the health, safety, and well-being of residents, particularly during the critical stage when a resident is first admitted to a facility,”

A recent case in Pennsylvania ruled that a nursing home’s arbitration agreement requiring a resident, “Fay V.” to pay half the costs of arbitration was “unconscionable.” Kohlman v. Grane Healthcare Company (Pa. Super 118, J-A25034-21, July 5, 2022). The ruling arose after the estate for Ms. V., who died three months after admission, filed a wrongful death lawsuit against the nursing home and other defendants.

According to the court transcripts, at the time of her admission, Fay V. was 67 years old and was suffering from a number of conditions, including congestive heart failure, diabetes, and pressure ulcers. The nursing home’s assessment of her condition at the time of her admission reported that “she was alert and oriented and had no memory problems or dementia, but that she was also suffering from anxiety and sometimes had trouble concentrating.”

It’s assessment also reported that ‘Fay’s vision was impaired to the point that even with glasses, she was ‘not able to see newspaper headlines but can identify objects.’ Yet upon her admission to Highland Park, she signed a number of documents, including a seven-page Nursing Services Agreement, a two-page Agreement to Arbitrate Disputes (the Arbitration Agreement), and a Resident Representative Agreement concerning the handling of her finances, in which Decedent designated herself as her representative.

In trial court, the court ruled the Arbitration Agreement as unconscionable (excessively unreasonable) because Decedent was in pain and was medicated at the time that she signed the Arbitration Agreement, Decedent was alone when she was asked to sign the Arbitration Agreement, had no opportunity to read the Arbitration Agreement and was not given a copy to review, and the provisions of the Arbitration Agreement were not fully read or explained to Decedent.

Source: Nursing Home’s Arbitration Agreement Found ‘Unconscionable’ — and Unenforceable — in Wrongful Death Suit

Most Have No Plan for Long Term Care

August 15, 2022 / drussellcfp

HGC, an Aging-In-Place research and product development company based in Connecticut partnered with non-profit Arctos Foundation to survey Americans’ preparedness for long term care.

Key findings:

70% of respondents have no advance directive in place, and just one in ten have l ong-term care insurance.

Most respondents have not spoken with a family member or loved one about wishes for Long Term Care.

Those with a spouse or partner are more likely to expect a need for long-term care services and supports, but are no more likely to have long-term care insurance in place.

Source: Independent Research | HCG Secure

To help families understand and discuss the issues surrounding planning for long term care, we have two excellent flipbooks on the topic of Essential Estate Planning, and Understanding Long Term Care.

Joke-Telling Robots in Nursing Homes

August 11, 2022 / drussellcfp

“I went on a date with a Roomba last week — it totally sucked.”

Like a scene out of The Jetson’s, robots are now entertaining residents in nursing homes with stand up jokes, while also monitoring their health. By reading biometric data off of resident wrist bands, the robots are able to greet residents by name, know if they have missed medication, or detect depressed moods.

Source: So, a robot walks into a nursing home…