What are Young People Doing to Help Seniors in Isolation?

With the pandemic continuing to be a part of our world, family caregivers are increasingly concerned about loved ones isolated at home or in facilities.

Many seniors and their family caregivers have little human interaction in “normal” times, and the pandemic makes it even worse.

Research shows that isolation and loneliness are as detrimental to health as smoking 15 cigarettes a day, says AARP’s recent article entitled “Teens Reach Out to Isolated Older Americans Through Online Programs.”

However, some new programs and approaches that have come about in the coronavirus quarantine can have a positive impact far beyond the pandemic. Young people have become pivotal in helping alleviate the lonesome burden for our seniors. Let’s look at three virtual intergenerational programs that bring hope for the future.

Music and Games to Brighten Spirits. Fifteen-year-old Maya Joshi and her twin sister, Riya, started daily video calls with their grandparents when the pandemic took hold. Seeing how much their grandparents enjoyed it, Maya decided to do something to help other isolated older adults. She launched Lifting Hearts with the Arts in April. The intergenerational program involves young teen volunteers connecting online with senior residents in 17 Illinois nursing homes and assisted living facilities. They present musical performances, games and 1:1 video chats.

These virtual activities are making a significant impact and are improving the senior residents’ moods, said the director of programming at a nursing home in Springfield, Illinois. After one resident grew more comfortable with the technology, she began initiating video calls with her friends and family. These seniors now have something to look forward to and they like seeing young smiles on the screen.

Meals and conversation To Eliminate Loneliness. The Los Angeles-based Youth Movement Against Alzheimer’s (YMAA) YouthCare program, in partnership with the University of Southern California, has been training their young students to provide in-home nonmedical respite and cognitively stimulating activities for people living with dementia.

The program was suspended when the COVID-19 lockdown began. As a rapid response to the pandemic, YMAA reached out to their chapters in high schools and college campuses across the country to create Meals Together. It’s a program where young students have virtual visits during mealtime with those in early stages of dementia and their caregivers.

In only three months, 39 YMAA chapters are participating in the expanding program. They now serve 175 senior users. They partner with nonprofits, like Meals on Wheels and assisted living facilities, to identify older participants. Seniors can also sign up on their own.

Natashia Townsend, YMAA’s director of caregiving programs, says they describe the program to participants in early stages of dementia as a way to help the students as they prepare for their careers. “It makes them feel empowered to help someone else,” Townsend explains. The youth volunteers also find it rewarding. “It’s just a great way to connect, and a lot of our seniors are feeling lonely at this time; they just want to feel like they have a friend,” she says.

Reference: AARP (July 27, 2020) “Teens Reach Out to Isolated Older Americans Through Online Programs”

Does a ‘Senior Moment’ Mean Alzheimer’s?

When your memory starts to waver, its easy to assume the worst, even Alzheimer’s disease. Considerable’s recent article entitled “What it means when you can’t remember a word” says on its own, sometimes forgetting a word is a completely normal part of life. Whew! Psychologists call this experience “tip of the tongue” state. When you forget a word, it hasn’t disappeared from memory. Actually, it is still there, but in the moment of speaking something is preventing it from being fully accessed.

What prevents the retrieval of a word? A word is a collection of features: it has a meaning and associated meanings and images. It has a form, which includes its pronunciation, a written representation and a syllable and stress pattern. Psychologists also say it leaves traces in neural connections of how frequently or recently it’s been used. Word retrieval might be disrupted by an issue in activating one or just a few of those features. Stress, fatigue and distraction can also all result in insufficient activation for retrieval.

More serious issues that damage or slow the necessary neural connections can also cause problems for word retrieval, most notable Alzheimer’s disease. The inability to find words can also signal brain injury or infection, strokes and degenerative diseases. However, in those cases, word-forgetting will be only one of many symptoms. By itself, forgetting a word once in a while is a completely normal part of life.

Forgetting a word can be annoying. However, the situation usually resolves itself quickly.

Word-forgetting can cause seniors a special kind of distress. That’s due to the fact that they worry more about what it means about the health of their memory.

Some memory functions do decline with age and are signals of Alzheimer’s or other problems. However, tip of the tongue states are independent of that type of cognitive decline.

In a study of age-related increases of tip-of-the-tongue states showed that “even though increased age is associated with lower levels of episodic memory and with more frequent TOTs [tip of the tongue states], which can be viewed as failures to access information from memory, the two phenomena seem to be largely independent of one another.”

In other words, your failure to remember a word isn’t a general memory problem in most cases. It is just a failure to remember a word.

Regardless whether your memory and mental state is in tact or wavering, prepare for whatever the future holds with careful estate planning and elder care considerations.

Reference: Considerable (July 13, 2020) “What it means when you can’t remember a word”

Estate Planning for a Second Marriage

It takes a certain kind of courage to embark on a second marriage, even when there are no children from prior marriages. Regardless of how many times you walk down the aisle, the recent article “Establishing assets, goals when planning for a second marriage” from the Times Herald-Record advises couples to take care of the business side of their lives before saying “I do” in a second marriage. Changing the dynamic of your family calls for changes to your estate plan.

Full disclosure of each other’s assets, overall estate planning goals and plans for protecting assets from the cost of long-term care should happen before a second marriage. The discussion may not be easy, but it’s necessary: are they leaving assets to each other, or to children from a prior marriage? What if one wants to leave a substantial portion of their wealth to a charitable organization?

The first step recommended with remarriage is a prenuptial or prenup, a contract that the couple signs before getting married, to clarify what happens if they should divorce and what happens on death. The prenup typically lists all of each spouses’ assets and often a “Waiver of the Right of Election,” meaning they willingly give up any inheritance rights.

If the couple does not wish to have a prenup, they can use a Postnuptial Agreement (postnup). This document has the same intent and provisions as a prenup but is signed after they are legally wed. Over time, spouses may decide to leave assets to each other through trusts, owning assets together or naming each other as beneficiaries on various assets, including life insurance or investment accounts.

Without a pre-or postnup, assets will go to the surviving spouse upon death, with little or possibly nothing going to the children.

The couple should also talk about long-term care costs, which can decimate a family’s finances. Plan A is to have long-term care insurance. If either of the spouses has not secured this insurance and cannot get a policy, an alternate is to have their estate planning attorney create a Medicaid Asset Protection Trust (MAPT). Once assets have been inside the trust for five years for nursing home costs and two-and-a-half years for home care paid by Medicaid, they are protected from long-term care costs.

When applying for Medicaid, the assets of both spouses are at risk, regardless of pre- or postnup documents.

Discuss the use of trusts with your estate planning attorney. A will conveys property, but assets must go through probate, which can be costly, time-consuming and leave your assets open to court battles between heirs. Trusts avoid probate, maintain privacy and deflect family squabbles.

Creating a trust and placing the joint home and any assets, including cash and investments, inside the trust is a common estate planning strategy. When the first spouse dies, a co-trustee who serves with the surviving spouse can prevent the surviving spouse from changing the trust and by doing so, protect the children’s inheritance. Let’s say one of the couple suffers from dementia, remarries or is influenced by others—a new will could leave the children of the deceased spouse with nothing.

Many things can very easily go wrong in second marriages. Prior planning with an experienced estate planning attorney can protect the couple and their children and provide peace of mind for all concerned.

Reference: Times Herald-Record (Sep. 21, 2020) “Establishing assets, goals when planning for a second marriage”

Nursing Homes Impacted by COVID-19 Crisis
COVID-19 has drastically altered life for residents of nursing homes.

Nursing Homes Impacted by COVID-19 Crisis

Yahoo Finance’s recent article entitled “U.S. nursing homes face ‘a crisis on top of a crisis’ with coronavirus and funding woes” explains that the nursing home industry has been facing a financial shortfall since at least 2013, particularly for non-Medicare margins, according to the American Health Care Association (AHCA). Non-Medicare margins are the revenues and costs associated with Medicaid and private payers for all lines of business. They dropped 3% in 2018, an increase from the year prior. The industry has been in financial disarray long before the COVID-19 crisis.

Lack of funding is a big issue for nursing homes. “You layer COVID on top of that and… it’s a crisis on top of a crisis,” David Grabowski, a professor of health care policy at Harvard Medical School, told Yahoo Finance. “And that you started with a lot of nursing homes that didn’t have adequate staffing models, weren’t exactly strong at infection control, lacked resources in many, many regards, and then this hits, it’s definitely the industry.”

“Over 60% of people in the country that live in nursing facilities are dependent upon Medicaid,” AHCA President and CEO Mark Parkinson told Yahoo Finance. “And unfortunately, in most states, the Medicaid rates have been set at less than the actual cost to take care of the residents. So, it makes it very difficult to provide the kind of care that providers want when they’re underfunded so dramatically.”

In addition, Parkinson commented, “most of the people don’t understand that Medicaid is really a middle-class benefit, because if people live long enough to outlive their resources, it’s the only way that they can afford to be taken care of in a facility.”

Medicaid is a federal benefits program that gives health coverage to seniors, pregnant women, children, people with disabilities and eligible low-income adults. However, the federal government permits states to level the payment amounts long as they meet federal requirements.

“The failure to adequately fund Medicaid is primarily a problem with the states,” Parkinson said. “Each state gets to make its own decision on what its reimbursement will be for Medicaid. Although the national average is around $200 a day, the rate varies dramatically by states, and some states are as low as less than $150 a day. In the low funding states, like Illinois and Texas, the politicians just haven’t decided it’s an important enough priority to adequately fund it.”

According to the New York Times, the COVID-19 crisis that has swept the nation has infected more than 282,000 people at about 12,000 facilities as of June 26. It has killed more than 54,000. There are roughly 15,600 nursing homes in the U.S., with more than 1.3 million residents and over 1.6 million staff.

“It’s important to note that COVID hasn’t discriminated, so it’s not just those worst-quality nursing homes that have seen cases,” Grabowski said. “It’s been equally apparent across the high quality and low-quality facilities, high Medicaid and low Medicaid facilities. We’ve found that it’s really about where you’re located that has driven these cases.”

Adding to the financial situation is the fact that testing for coronavirus in the thousands of nursing homes across the country can be very expensive. The AHCA and National Center for Assisted Living (NCAL) found that testing every U.S. nursing home resident and staff member just once, would cost $440 million. As the pandemic continues, more supplies are also needed. A recent NCAL survey found that many assisted living communities are running low on PPE (N95 masks, surgical face masks, face shields, gowns, and gloves).

Parkinson says, it’s a “failure to recognize the importance of the elderly. It’s a conscious political decision to underfund elder care,” he said. “It’s not defensible on any level, but it’s occurring in the vast majority of states.”

Nursing homes were hardly prepared for the COVID-19 crisis. He went on to say that with more funding, nursing homes can be better prepared for the next health crisis.

Reference: Yahoo Finance (June 30, 2020) “U.S. nursing homes face ‘a crisis on top of a crisis’ with coronavirus and funding woes”

Long-Term Care Costs and Your Estate Plan

Illinois medicaid planningThere are many misunderstandings about long-term or nursing home care and how to plan from a financial and legal standpoint. The article “Five myths about nursing home costs and estate planning” from The Sentinel seeks to clarify the facts and dispel the myths. Some of the truths may be a little hard to hear, but they are important to know.

Myth One: Before any benefits can be received for nursing home care, a married couple must have spent at least half of their assets and everything but $120,000. If the person receiving nursing home care is single, they must spend almost all assets on the cost of care, before they qualify for aid.

Fact: Nursing homes have no legal duty to advise anyone before or after they are admitted about this myth.

Several opportunities to spend money on items other than a nursing home, include home improvements, debt retirement, a new car and funeral prepayment. An elder law attorney will know how to use a Medicaid-compliant annuity to preserve assets, without spending them on the cost of care, depending on state law.

There are people who say that an attorney should not help a client take advantage of legally permitted methods to save their money. If they don’t like the laws, let them lobby to change them. Experienced elder law and estate planning attorneys help middle-class clients preserve their life savings, much like millionaires use CPAs to minimize annual federal income taxes.

Myth Two: The nursing home will take our family’s home, if we cannot pay for the cost of care.

Fact: Nursing homes do not want and will not take your home. They just want to be paid. If you can’t afford to pay, the state will use Medicaid money to pay, as long as the family meets the eligibility requirements. The state may eventually attach a collection lien against the estate of the last surviving homeowner to recover funds that the state has used for care.

A good elder law attorney will know how to help the family meet those requirements, so that the adult children are not sued by the nursing home for filial responsibility collection rights, if applicable under state law. The attorney will also know what exceptions and legal loopholes can be used to preserve the family home and avoid estate recovery liens.

Myth Three: We’ve promised our parents that they’ll never go to a nursing home.

Fact: There is a good chance that an aging parent, because of dementia or the various frailties of aging, will need to go to a nursing home at some point, because the care that is provided is better than what the family can do at home.

What our loved ones really want is to know that they won’t be cast off and abandoned, and that they will get the best care possible. When home care is provided by a spouse over an extended period of time, often both spouses end up needing care.

Myth Four: I love my children equally, so I am going to make all of them my legal agent.

Fact: It’s far better for one child to be appointed as the legal agent, so that disagreements between siblings don’t impact decisions. If health care decisions are delayed because of differing opinions, the doctor will often make the decision for the patient. If children don’t get along in the best of circumstances, don’t expect that to change with an aging parent is facing medical, financial and legal issues in a nursing home.

Myth Five: We did our last will and testament years ago, and nothing’s changed, so we don’t need to update anything.

Fact: The most common will leaves everything to a spouse, and thereafter everything goes to the children. That’s fine, until someone has dementia or is in a nursing home. If one spouse is in the nursing home and receiving government benefits, eligibility for the benefits will be lost, if the other spouse dies and leaves assets to the spouse who is receiving care in the nursing home.

A fundamental asset preservation strategy is to make changes to the will. It is not necessary to cut the spouse out of the will, but a well-prepared will can provide for the spouse, preserve assets and comply with state laws about minimal spousal election.

When there has been a diagnosis of early stage dementia, it is critical that an estate planning attorney’s help be obtained as soon as possible, while the person still has legal capacity to make changes to important documents.

The important lesson for all the myths and facts above: see an experienced Orland Park estate planning elder law attorney to make sure you are prepared for the best care and to preserve assets. The Attorneys at Michael T. Huguelet, P.C. are anxious to assist you and your family through this difficult and confusing process. If you need assistance with estate planning of any sort, contact our Lemont estate planning attorneys at 708-852-0733 for help.

Reference: The Sentinel(May 10, 2019) “Five myths about nursing home costs and estate planning”