Category Archives: Housing

Talking With Family About Placement

Few decisions are more difficult than the one to place a spouse or parent in a nursing home. Since nursing homes are seen as a last resort, the decision is generally overlaid by a sense of guilt. Most families try to care for loved ones at home for as long as (or longer than) possible, only accepting the inevitable when no other alternative is available.

The difficulty of making the decision can be compounded when family members disagree on whether the step is necessary. This is true whether the person disagreeing is the person who needs help, his or her spouse, or a child.

The placement decision can be less difficult if, to the extent possible, all family members are included in the process, including the senior in question, and if everyone is comfortable that all other options have been explored. This will not ensure unanimity in the decision, but it should help.

We recommend the following steps:

  1. Include all family members in the decision. Let them know what is happening to the person who needs care and what providing that care involves. If possible, have family meetings, whether with the family alone or with medical and social work staff where available. If you cannot meet together, or in between meetings, use the telephone, the mail, or the Internet.
  2. Research other options. Find out what care can be provided at home, what kind of day care options are available outside of the home, and whether local agencies provide respite care to give the family care providers a much-needed rest. Also, look into other residential care options, such as assisted living and congregate care facilities. Local agencies, geriatric care managers, and elder law attorneys can help answer these questions.
  3. Follow the steps above for finding the best nursing home placement available. If you and other family members know you’ve done your homework, the guilt factor can be assuaged (at least to some extent).
  4. Where necessary, hire a geriatric care manager to help in this process. While hospitals and public agencies have social workers to help out, they are often stretched too thin to provide the level of assistance you need. In addition, they can have dual loyalties, to the hospital that wants a patient moved as well as to the patient. A social worker or nurse working as a private geriatric care manager can assist in finding a nursing home, investigating alternatives either at home or in another residential facility, in evaluating the senior to determine the necessary level of care, and in communicating with family members to facilitate the decision. To find a geriatric care manager in your area, visit the Web site of the National Association of Professional Geriatric Care Managers at www.caremanager.org.

These steps cannot make the decision easy, but they can help make it less difficult.

Is It Better to Remarry or Just Live Together?

Finding love later in life may be unexpected and exciting, but should it lead to marriage? The considerations are much different for an older couple with adult children and retirement plans than for a young couple just starting out. Before deciding whether to get married or just live together, you need to look at your estate plan, your Social Security benefits, and your potential long-term care needs, among other things. Whatever you decide to do, you may want to consult an elder law lawyer to make sure your wishes will be carried out.

Here are some things to think about:

  • Estate Planning. Getting married can have a big effect on your estate plan. Even if you don’t include a new spouse in your will, in most states spouses are automatically entitled to a share of your estate (usually one-third to one-half). One way to prevent a spouse from taking his or her share is to enter into a prenuptial agreement in which both spouses agree not to take anything from the other’s estate. If you want to leave something to your spouse and ensure your heirs receive their inheritance, a trust may be the best option.
  • Long-Term Care. Trusts and prenuptial agreements, however, won’t keep a spouse from being responsible for your long-term care costs or vice versa. In addition, getting married can have an effect on your or your spouse’s Medicaid eligibility. If you can afford it, a long-term care insurance policy may be a good investment once you remarry.
  • The Family Home. Whether you are getting married or just living together, before combining households you will need to think about what will happen to the house once the owner of the house dies. If the owner wants to keep the house within his or her family, putting the house in both spouse’s names is not an option. On the other hand, the owner may also not want his or her heirs to evict the surviving spouse once the owner dies. One solution is for the owner of the house to give the surviving spouse a life estate. Once the surviving spouse dies, the house will pass to the original owner’s heirs.
  • Social Security. Many divorced or widowed seniors receive Social Security from their former spouses, and remarriage can affect benefits. If you are divorced after at least 10 years of marriage, you can collect retirement benefits on your former spouse’s Social Security record if you are at least age 62 and if your former spouse is entitled to or receiving benefits. If you remarry, you generally cannot collect benefits on your former spouse’s record unless your later marriage ends (whether by death, divorce, or annulment). However, if your are a widow, widower or surviving divorced spouse who remarries after age 60, you are entitled to benefits on your prior deceased spouse’s Social Security earnings record.
  • Alimony. If you are receiving alimony from a divorced spouse, it will likely end once you remarry. Depending on the laws in your state and your divorce settlement, alimony may end even if you simply live with someone else.
  • Survivor’s Annuities. Widows and widowers of public employees, such as police officers and firefighters, often receive survivor’s annuities. Many of these annuities end if the surviving spouse remarries. In addition widows and widowers of military personnel may lose their annuities if they remarry before age 57. Before getting married, check your annuity policy to see what the affect will be.
  • College Financial Aid. Single parents with children in college may want to reconsider before getting married. A new spouse’s income could affect the amount of financial aid the college student receives. Some private colleges may even count the combined income of a couple that lives together if they commingle their expenses

How to Prepare When Elderly Parents Move In with Adult Children

More and more parents are moving in with their adult children, and the trend probably won’t reverse anytime soon. As nursing home costs continue to rise, children and their parents are finding that living together is a better arrangement, both financially and emotionally. But having a parent move in is a big adjustment for everyone, and it is important to be prepared. Preparations can range from making physical adjustments to the house to figuring out finances. The following are some things to think about.

Work out the financial details first. If the adult children have siblings, the question of whether the siblings are going to contribute to the parents’ room and board can be sensitive. Even if there are no siblings, there is still the question of how much the parents can or should contribute to the household. An extra person to feed can be expensive. It can get even more costly if you need to do major renovations or hire a home health care worker.

There are many considerations that can have tax or other consequences. Should the parents have a contract in which they pay the children for caring for them? If the parents contribute to remodeling the house, do they gift their portion of the house to the children, retain an interest, or put it in a trust? These and other decisions can affect the parents’ eligibility for Medicaid if it becomes necessary for the parents to enter a nursing home at some point.

To avoid fostering resentment and guilt among family members, you should try to work out as many of these issues as you can before the big move. An elder law attorney can help your family create a plan that takes all the various contingencies into account, so that everyone is on the same page and knows what to expect

Make the home senior friendly. Whether adding an addition or just fixing up a spare bedroom, adjustments will probably have to be made to accommodate the parent or parents. Some basic adjustments include replacing doorknobs with levers, checking railings to make sure they are sturdy, installing grab bars in the bathroom, and putting non-slip backings on rugs. More significant changes could be converting a room on the first floor into a bedroom, widening doors to allow a wheelchair or walker to pass through, and installing ramps.

In addition to these accommodations, the space should be personalized for the parents. Consider the parents’ likes and dislikes and what would make them feel at home when renovating. It is important that even if the parents have only a bedroom of their own, they feel like it is their space.

Look into a tax deduction. When considering the financial details of this new arrangement, keep in mind that the children may be able to claim the parents as a dependent and get a tax deduction if they provide more than half of the parents’ support during the year.

Know where to go for help. If family members are serving as caregivers, they don’t need to feel like they are doing this all alone. There a number of services that are designed to help caregivers. From home health care workers to meals programs and transportation services to adult day care centers and respite services, there are a number of different ways to get help. Contact an Area Agencies on Aging program in your state to find out the services in your area. In addition a number of resources are available to provide caregivers with information and support. The following are some books that may help caregivers understand what to expect: How to Care for Aging Parents, How to Care for Your Parents’ Money While Caring for Your Parents, and The Complete Idiot’s Guide to Caring for Aging Parents.

Multigenerational Living

By: Rajiv Nagaich

The recent economic downturn brings to light the obvious – the vulnerability of anyone who has not prepared to weather the financial storm. According to a recent report, Living Longer on Less: The New (In)security of Seniors, produced by The Institute on Assets and Social Policy (IASP), a research institute at the Heller School for Social Policy and Management at Brandeis University (http://iasp.brandeis.edu/pdfs/LLOLReport.pdf), 78 percent of all senior households are financially vulnerable. The vulnerability comes from inability to meet housing costs and healthcare costs, negative budgets, lack of available home equity and lack of adequate assets. Many seniors will succumb to these vulnerabilities and be rendered dependent on state aid. A significant number of those who succumb to state aid do so because of prohibitively high healthcare costs, particularly long-term care costs, which are generally not covered by Medicare or any health insurance plans (other than long-term care insurance policies, which few seniors have).

Other societies have found answers in multigenerational living arrangements. Such a system did indeed flourish in this nation as well and continues to exist to some extent even today. However, it is all but lost to the majority of seniors, who throughout their lives expected to remain independent all the way to the end and not become a burden on their children. As a society we have succeeded in creating an expectation of self-reliance. The issues such an expectation creates are nothing short of heartbreaking in most cases.

Take, for example, a recent conversation I had with a dear friend of mine who has been caring for his wife for over 14 years. In his early 60′s, my friend’s wife was diagnosed with early-onset Alzheimer’s disease. He took care of her, encouraging his children to live their lives while he took early retirement to care for his wife. As time passed, the care needs became more significant and he tried home healthcare and day health services, which met the needs for a while. However, in the end, with no dependable assistance from family members, my friend found no other solution than to place his wife in an institutional setting, which cost him over $90,000 each year. He searched for a legal solution to try and preserve his estate of about $700,000. At the present rate this nest egg would have allowed him to care for his wife for at least seven years, but for the current economic downturn. Worried stiff about the dwindling resources, my friend opted to divorce his wife in order to obtain Medicaid benefits to cover her significant care costs and to protect his savings for his own future care needs. And this is not the sad part.

In our conversation my friend was lamenting the fact that his decision had alienated him from his children, not that they ever made time to help him with his wife’s care needs before he decided to divorce her. In fact, they had visited her no more than a handful of times throughout the past year, just as they did with him. The previous Christmas none of his children invited him to their house, even though he had arranged for a gathering on December 27th with all of them. By coincidence, a few days before Christmas he happened to run into his son, daughter-in-law and family at a restaurant. In this chance meeting his daughter-in-law told him she was busy getting ready for a large crowd coming to their house on Christmas (her side of the family); as an afterthought she added that if my friend was bored at home he could drop in. Devastated, my friend chose not to say anything about it. But the episode looms large and gnaws at him each day. Are these the children he raised? Is this what life amounts to in the end?

Multigenerational living is not a solution for all families, not because we lack the capacity to live it but because the lifestyle is alien to us. Our drive to live independently and not be a burden on our children has become all too common. We are the sad victims of our own success. And unless attitudes change, silent devastation will continue to victimize most of us in a time when we are most vulnerable.

In my own family, my mother-in-law lived with us for 11 years. It was more of a culture shock for my wife than it was for me, chiefly because I was born in India, where multigenerational families are the norm. My wife, a native of Spokane, Washington, was raised to focus on her own nuclear family. My wife and I often discuss this issue and come away with different observations. Her observation is that because she saw my willingness to coexist under the same roof, she was able to accept that arrangement and it worked out fine. In my opinion, the reason we were able to live 11 years, the last two years of which my mother-in-law battled cancer, was because she joined our home when she was able to contribute to our lives as well. She was able to form a bond with our three young children. She was able to assist with shopping, laundry and other household chores. The house was a home and she was a permanent part of it. When she grew weak, all our family members pitched in just as we would have if one of the children needed our time and attention. And in the end, we were all the better for it, though during the process we all made sacrifices. My mother-in-law gave up privacy and the freedom to go to casinos, movies, or just remain free from interfering toddlers; we were forced to include our mother-in-law on our vacations, we lost our privacy, and saw our children miss out on summer vacations with their grandmother in a distant town. But what we gained was immeasurable. Our children learned values from an era that is bygone. They heard stories about grandma’s life as a little girl, becoming the first female student from her town to go to nursing school, and countless other moments that they will no doubt recount for the rest of their lives. They also got piano lessons from grandma, patient cooking lessons in the kitchen and lots of hugs and kisses for the asking anytime they so desired. We were richer from sharing in these stories and showing our children that multigenerational living is the norm, not the exception, in this family. Together we said goodbye to Vivian in her own bedroom when she said goodbye to this world. Our children learned the most valuable lesson we tend to hide from our children: that death is part of life. And though grandma is not here, she lives on in our hearts. There are still tears for grandma (and mother), but we have more happy memories than would ever have been possible if grandma had been a part-time family member, someone we visited every now and then.

In the end, it is a simple proposition. In today’s America multigenerational living is not a lifestyle that is the norm and it is misunderstood. We as a society have created an expectation for ourselves that we should be able to live independently and not be a burden on our children. We have also created an expectation that our children should be focused on their nuclear families to the exclusion of parents and other family members. Therefore, making sacrifices due to loss of freedom and independence when there are others living under the same roof is not easily accepted. Furthermore, the desire to live independent lives fails to create common bonds between the multigenerations that are coming together. So when incapacity strikes, it truly becomes a burden on the family because their bonds cannot sustain them during tough times.

If this is to change, it must begin with parents who change their attitudes about being a burden on their kids and instead focus on becoming more relevant in the lives of their children while they are mentally and physically able. Parents must shift their focus away from golfing and stop spending their golden years excluding family members. It must be understood that making occasional holiday visits and sending gifts on birthdays and anniversaries is not enough to sustain the bonds that will be needed to see a family through the tough times. We must redefine a family to include not only a husband, wife, partner and children but also parents, uncles and aunts. And that means living under the same roof. Today’s larger homes can usually accommodate such living.

We must learn to make sacrifices that will be necessary to make the transition. Classes need to be offered to make this happen. Children must see parents not as outsiders but as family members.

Multigenerational living will make old age more pleasant and meaningful, and financially more viable; it will lead to a society that can find meaning in relationships that matter most. Quality of life and financial expectations can both be met through this mode of living arrangement.

Helping Your Older Parents Stay Happy and Healthy

By Robert Stall MD, Geriatrician

If you’re fortunate enough to have one or both parents still living, you may have noticed a role reversal taking place in your relationship. Remember the days when Mom shuttled you to the doctor whenever you were sick? Now, it may be you who’s driving her to her medical appointments. Perhaps you’ve become even more involved in managing her healthcare needs – serving as her healthcare proxy, moving her into your home to care for her, or even having to select a nursing home for her to live in.

Whatever the case, it’s natural to feel challenged – and, yes, intimidated – in the role you’ve undertaken. But if you stay positive and proactive, you’ll be in a great position to advocate for your parents’ optimal care. And, really, what better way is there to say “Thank You” for all they’ve done for you over the years?

The following six recommendations will help you understand what may be happening to your parents as they age – and what you can do to help.

1. Stay vigilant to sudden changes.
Typically, sudden changes arise from sudden problems. Your elderly father who becomes confused one week but was alert and oriented the week before, or becomes unsteady walking and starts falling, is likely experiencing an acute problem – an infection, medication side effect, or perhaps, a heart attack or stroke.

If you pay attention to your parent’s baseline health and behavior, you’ll be alert to sudden, and subtle, fluctuations. Being attuned to what’s “normal” for your parent is critical in advocating for his care. By informing his physician of these changes, you help ensure that he receives a proper diagnosis and timely treatment – especially important in acute conditions.

2. Investigate the source of gradual decline.
Several years ago, I met an elderly woman living in a nursing home. Her family, assuming she had dementia, had moved her there after she had gradually stopped speaking.

After performing a brief procedure on her, I asked how she was doing. “I’m OK,” she replied.

A miracle? Not exactly. I’d removed bullet-sized pieces of wax from her ears. She’d stopped speaking because her ears were too plugged to hear.

A host of conditions can cause gradual decline. Before jumping to the conclusion – as many people do – that Alzheimer’s disease is the culprit, recognize that your parent may be experiencing an altogether different problem: a vitamin B12 deficiency, an underactive thyroid, Parkinson’s disease or depression, to name a few.

When discussing your parent’s decline with her physician, make sure the two of you consider all the possibilities. To prepare for the appointment, make notes detailing how her decline has manifested itself – loss of appetite, a failing short-term memory and so forth – and how long you’ve noticed these changes. That way, you won’t leave anything out. To help you, I’ve created a free checklist that either you or your parent can complete at seniorselfassessment.com – make sure you print or email the “Test Result Details” at the bottom of the page to analyze your responses and give you advice based on your answers.

3. Know thy parent’s medicine cabinet.
Familiarize yourself with the medications your parent takes: what each one is for and how often he takes them. Make sure you notify each doctor your parent visits of all the medicine he takes, including over-the-counter products. Ask what side effects you might observe from each medication and whether it’s potentially dangerous if your parent takes them together. You also want to tell the doctor whether your parent drinks alcohol or caffeinated drinks and whether he smokes, as these substances can affect some medications’ efficacy and safety. To recognize which medications might cause the symptoms your parent experiences, check out drugscanmakeyousick.com .

4. Discourage ageist attitudes.
Simply put, ageism is prejudice against the elderly. It exists in many forms but can be particularly damaging to an older person’s self-esteem when it assumes that all of her woes are age-related. Here are a couple of ways of expressing ageism to an elderly parent:

“What do you expect at your age?”
“You’re not getting any younger.”

If you’re ever tempted to utter something similar, remind yourself that by chalking up everything that ails her to her age, you sell your parent short. If she’s depressed, it may have nothing to do with the fact that she’s 80 and everything to do with a biological predisposition to depression. And remember that right-knee pain in a 90 year-old can’t be just from age if there’s no problem with her left knee.

5. Address not just symptoms—but emotions, too.
There is disease and then there is “dis-ease” – that is, a lack of ease, security or well-being. “Dis-ease” can manifest itself as myriad emotions in an elderly person: fear, grief, boredom, embarrassment and sadness among them. The fact is, these emotions can be every bit as debilitating as disease.

Take the case of a parent who’s incontinent. Too embarrassed to socialize, she cuts herself off from friends. Without companionship, she becomes lonely. Instead of allowing her to become a hermit, discuss with her doctor how to address the incontinence. Together, you can consider different solutions that will ease her embarrassment and reinvigorate her social life.

6. Strive to maximize your parent’s quality of life.
No matter our age, we all want to enjoy life to the fullest and have the capability to do the things we want to. Improving the enjoyment of life and a patient’s functional ability are the cardinal goals of geriatric care. But you don’t need a medical diploma on your wall to help your parent achieve either of those goals.

Being there to solve a problem or provide company are tremendously worthwhile services you can provide – no expertise required. Remember, as your parent gets older, his quality of life becomes more important to him than how much longer he lives. And he doesn’t necessarily need medications or surgery to ensure that he’s living the latter part of his life to the fullest.

If he enjoys books but has difficulty reading regular-sized type, check out sight-saving titles at the library. If he’s grieving the loss of his best buddy, introduce him to new acquaintances at the senior center. If he’s living in a nursing home, bring your kids there to share a meal with him.

Sometimes, it’s the small gestures that have the most profound impact. As the child of an elderly parent, you are uniquely positioned to deliver these life-changing gifts.

Dr. Robert Stall is a geriatrician practicing in Tonawanda, New York and a clinical associate professor at the University of Buffalo’s School of Medicine and Biomedical Sciences. He serves as medical director and attending physician at Beechwood Homes in Getzville and Blocher Homes in Williamsville.

Keeping Mom and Dad Safe

Generally, elderly parents want to remain living in their own home. However, remaining in the home becomes a concern when children see their parents slowing down, perhaps even having trouble with handling stairs and doing general daily activities. Yet, with parents’ mental and physical health currently not creating problems, there seems to be no imminent need to search out support services or other accommodations for aging parents.

This is now the time to evaluate the home to make it safe and secure for your loved ones — now and in the near future — in anticipation of aging disabilities that may occur. Help and support are available. The nation as a whole is more aware of elderly needs and services and products are becoming available at an outstanding pace.

The Bureau of Labor Statistics states,

“Employment of personal and home care aides is projected to grow by 51 percent between 2006 and 2016, which is much faster than the average for all occupations. The expected growth is due, in large part, to the projected rise in the number of elderly people, an age group that often has mounting health problems and that needs some assistance with daily activities.” Bureau of labor Statistics-Occupational Outlook Handbook, 2008-09 Edition

This growing need for aides and services also encompasses

  • Home remodeling services — making a home more serviceable to the elderly;
  • Safety alert systems and technology;
  • Motion sensors to monitor movement;
  • Tele health services — using home-based computer systems for the doctor’s office or a nurse to monitor vital signs and
  • A pill dispenser that notifies when it is time to take medication.

Where do you begin to make sure your elderly family member is safe and managing well in his or her home?

Visit often and at different times of the day and night. Make note of daily activities that appear challenging and where changes might be made to add safety and convenience. Remove rugs that slide — causing a fall — and move furniture with sharp edges. Set the water heater at a lower temperature. This will protect their older sensitive skin from scalds and burns. Be sure smoke detectors and carbon monoxide detectors are in place.

Bathrooms are a hazard area for the elderly. Grab bars by the toilet and shower are a must to help prevent falls. There are easy to install bars at your local hardware store if you want to do the work yourself. Another item that is good to have is a shower stool or chair.

If you are not sure of what needs to be done, consider hiring a professional. There are companies that specialize in home remodeling and accommodation for seniors. Michelle Graham of Accessible Design by Studio G4 says about senior home remodel projects,
“The main thing we incorporate in all of our projects is a careful study of needs and potential needs that may develop throughout a client’s lifespan.”

Keep in mind what future home adjustments might be needed for your parents to “age in place” in their home.

Home safety or medical alert companies provide GPS-based bracelets or pendants to track the elderly at home who tend to wander. Or the companies may provide alarm devices such as pendants or bracelets which allow the elderly to alert someone if there has been a fall or a sudden health-related attack. In the event an alarm has been triggered, a 24 hour monitoring service will alert the family or medical emergency services or call a neighbor depending on previous instructions. In addition there are companies that will install motion sensors in the home to monitor the elderly on a 24 hour basis.

Don’t forget your parents’ communities as a valuable resource for helping them stay in their home. Take Margaret Muller as an example. At 82 years of age, Margaret lives alone in her small home. She manages very well with the help of her local Senior Center. The Center’s “Senior Companion” program sees that Margaret is taken to the store for groceries and other needs and checks in with her often to see how she is doing. Once a day, the Senior Center delivers a hot healthy meal to her door. Having these services and visits gives Margaret the help she needs and peace of mind that she is not alone.

Neighbors, local church groups, senior centers and city centers are some places to look for assistance. Most of the time there is little or no cost for these services.

Your state aging services unit is a valuable community resource. The National Area on Aging website www.aoa.gov states:

“AoA, through the Older Americans Act and other legislation, supports programs that help older adults maintain their independence and dignity in their homes and communities. In addition AoA provides funding for a range of supports to family caregivers.”

Some of the programs the site lists are:

“Supportive Services and Senior Centers
Nutrition Services
National Family Caregiver Support Program
Grants for Native Americans
Nursing Home Diversion Grants
Aging & Disability Resource Centers
Evidence-Based Disease Prevention
Long-Term Care Planning
Alzheimer’s Disease Grants
Naturally Occurring Retirement Communities”

A few thoughts on hiring home care aides or live-in care givers.

The classifieds are filled with people looking for work as aides to the elderly. Many of these aides are well-qualified, honest people who will do a good job; but, of course, there will be some not so reputable. If you are looking to hire someone, be sure you interview and check references and qualifications. You will be responsible for scheduling that person and doing payroll and taxes as well. Be very sure you hire someone trustworthy, as the elderly seem to trust these helpers more than they should and therefore can easily be taken advantage of.

A professional home care service will eliminate your employment concerns. Professionally-provided aides are usually bonded and service is guaranteed. Home care companies take care of the scheduling and payment of their employees. Home care companies cater to the elderly in their homes by offering a variety of services.

These providers represent a rapidly growing trend to allow people needing help with long term care to remain in their home or in the community instead of going to a care facility. The services offered may include:

  • companionship
  • grooming and dressing
  • recreational activities
  • incontinent care
  • handyman services
  • teeth brushing
  • medication reminders
  • bathing or showering
  • light housekeeping
  • meal preparation
  • respite for family caregivers
  • errands and shopping
  • reading email or letters
  • overseeing home deliveries
  • dealing with vendors
  • transportation services
  • changing linens
  • laundry and ironing
  • organizing closets
  • care of house plants
  • 24-hour emergency response
  • family counseling
  • phone call checks

Thomas Day, Director of the National Care Planning Council states,
“Care in the home provided by a spouse or a child is the most common form of long-term care in this country. About 73% of all long term care is provided in the home environment typically by family caregivers.”

As their caregiver, you can make the difference in the quality of life for your aging parents and if staying in their home is a possibility, you have the resources to make it happen.

Nursing Homes Evicting Costly Residents at a Faster Pace

The Wall Street Journal Reports

Last Updated: 8/7/2008

Nursing home evictions of frail and ill residents are rising, according to an article in the Wall Street Journal. The U.S. Administration on Aging reports that formal complaints of eviction practices have doubled over 10 years to 8,500 in 2006, and the practice of involuntary nursing home evictions may be far more prevalent because not all residents file complaints.

“Across the board, involuntary discharge numbers have risen in recent years,” says Louise Ryan, Washington state’s long-term-care ombudsman. “It’s a real problem.”

Most vulnerable to eviction are residents with dementia or demanding families, particularly if they are on Medicaid. Nursing facilities get as little as half from Medicaid beneficiaries as they can get from residents who pay out-of-pocket, with private health insurance or using Medicare’s very short-term nursing home coverage.

Nursing homes may be breaking federal law in evicting residents they no longer wish to care for, but proving this can be a difficult and protracted process. The federal nursing home law permits residents to be discharged involuntarily for only six reasons: if they are healthy enough to go home; if they need care the nursing come cannot provide; if they endanger the health or safety of others; if they do not pay their bills; or if the nursing home closes.

Although nursing homes frequently list one of these six reasons for eviction, “advocates for the elderly say it can be a stretch,” the Journal reports. The article states that although facilities “rarely roll evicted residents out to the curb,” they often “transfer [residents] to another nursing home or send them to a hospital or psychiatric facility for treatment and observation and then refuse to take them back.” Social workers sometimes refer to this process as “nursing-home dumps.”

The American Health Care Association, a nursing home industry group, says it is unaware of widespread problems with evictions, especially ones focusing on Medicaid residents

In a sidebar article, the Journal points out that the strong protections that nursing home residents have — at least on paper — don’t apply to residents of assisted-living facilities, where those who are “dependent on Medicaid are particularly vulnerable to eviction.”

Nursing Home Facts

Nursing Home Myths and Realities

 

Myth: Medicaid does not pay for the service you want.

Reality: Medicaid residents are entitled to the same service as other residents.

 

Myth: Only staff can determine the care you receive.

Reality: Residents and family have the right to participate in developing a care plan.

 

Myth: Staff cannot accommodate individual schedules.

Reality: A nursing home must make reasonable adjustments to honor residents’ needs and preferences.

 

Myth: You need to hire private help.

Reality: A nursing home must provide all necessary care.

 

Myth: Restraints are required to prevent the resident from wandering away.

Reality: Restraints cannot be used for the nursing home’s convenience or as a form of discipline.

 

Myth: Family visiting hours are restricted.

Reality: Family members can visit at any time of day or night.

 

Myth: Therapy must be discontinued because the resident is not progressing.

Reality: Therapy may be appropriate even if resident is not progressing; Medicare may pay even without current progress.

 

Myth: You must pay any amount set by the nursing home for extra charges.

Reality: A nursing home may only require extra charges authorized in the admission agreement.

 

Myth: The nursing home has no available space for residents or family members to meet.

Reality: A nursing home must provide a private space for resident or family councils.

 

Myth: The resident can be evicted because he or she is difficult or is refusing medical treatment.

Reality: Being difficult or refusing treatment does not justify eviction.

 

Source:Twenty Common Nursing Home Problems and the Laws to Resolve Them” by Eric Carlson, J.D. Originally published in Clearinghouse Review Journal of Poverty Law and Policy, January/February 2006 39(910):51933

Checklist for Nursing Home Selection

Choosing a nursing home for a family member can be one of the most difficult decisions anyone ever has to make. The fact that he needs to move to a nursing home means that he is in a vulnerable state and will be dependent on the care provided him in the facility. The following considerations should help choose the best facility in an unfortunate situation:

  1. Facility Certification and Financial Matters: Is the facility certified by Medicare and Medicaid? How long has the facility been certified?
  2. Specialty Care Available: Does the facility have an Alzheimer’s unit or other special care area restricted to patients with special care needs? Is the specialty unit separated from other areas of the facility?
  3. Location: How convenient is the location to family members and friend? What are visiting hours? Location is important, because it can affect how often the patient is visited by family and friends. Frequent visits generally will improve the patient’s mental and emotional well being, as well as ensure that quality of care issues can be addressed as problems arise.
  4. Physical Consideration: Is the facility well lit, clean, safe, and welcoming? What diagnostic treatment facilities are available at the facility? What bathing facilities are available and how is bathing handled when the person needs assistance?
  5. Staffing: What is the ratio of staff to residents during each shift?
  6. Mental & Emotional Well Being of Patients: What kind of activities are planned each day for the residents? A good activities program should have regularly scheduled events, such as a weekly movie or musical event (even if it is just a “sing along” ), religious services, physical exercise activities (exercise classes or even dancing), bingo, educational classes, and other social events. Is there a library available for residents with large print and audio books? Is there a small for “store” for purchasing personal items, such as shaving cream, hair care products, and snacks? Is there a safe place for residents to enjoy outdoor areas, such as an enclosed garden? Are plants, pets, and other natural elements added to the residents’ environment? Are residents taken to special community events and cultural activities?
  7. Room Sharing and Furnishings: Will the resident share a room and/or a bathroom with one or more other residents? How are roommates and rooms selected? If the resident is dissatisfied, can roommates be changed and how is that accomplished? Can the resident bring some of his or her own furniture?
  8. The Resident’s Care Plan: Individual care plans must be implemented with each resident. How often is the care plan reviewed and changed? What is the protocol for handling problems? A resident of a nursing home must be under the care of a licensed physician. The physician must evaluate the resident’s needs and prescribe a program of medical care, including therapy, diet restraints, and medication.
  9. Employees: How are employees selected? How are employees screened for drug use, criminal records, and other potential problems? What is the turnover rate for skilled employees? What is the turnover rate for employees who perform ancillary services, such as meal preparation and financial record keeping?
  10. Physician: If there is a physician that is used by the majority of residents, what are her qualifications? How often is the doctor on premises? What is her bedside manner with residents?
  11. Meals: Are meals served in a communal dining room or is each resident brought her meal in her room? If communal, how are tables assigned in the dining room? How long does it take for a meal to be delivered to a bedridden resident? How does the food taste and how is it presented to the resident? Is there a means of heating food that has become cold?
  12. Admission Requirements: What financial information will the facility require during the admissions process? Can the patient or his representative have copies in advance of all admissions documents and contracts for review? How long does the process take?
  13. Cost of Care: What is included in the cost of care? How are “extra” items billed? Can laundry be taken off premises and does this save the resident some costs? How is prescription drugs handled? What is the cost difference between a private room and a semi-private room?
  14. Transportation Services: If required non-emergency medical services are not available on premises (such as dialysis), how is transportation arranged? What about transportation to other places, such as local stores and religious services?

Caretaking Causing Family Problems

My mother recently passed away. My father is 94 years old. The trust contains a house, with my eldest sibling as the executor of the estate. My father does not have power of attorney set yet.  I have moved in with my father to take care of him, although I am still paying for my apartment until the end of the year.  I would like to live in the house for less than one year after he passes away to allow time to get the house ready to sell and find my own place. Am I being unreasonable?

My father is worried about making anyone upset and is unwilling to sign anything stating I can stay here although he has told me he does not have a problem with it, though others might.  What should I do?

It is not unusual for caring family members and children to step up to the plate to make someones life better.  The alternative to this is that it is likely that if she does not step up to the plate the father will have to go to an institutional care setting. If in a family of several children, one child steps up, it is my experience that the other children will be thankful that they do not have to give up their lives.  But at the end of the day, when the father passes, everyone seems to forget. Everyone gets fixated on the issue of inheritance.

Your siblings need to come together with your dad and discuss what needs to happen for his needs. He can have it stated in his will that my daughter has the right to live here for one year, and no one will have the right to do anything.  If they cannot solve the issues, it may go to court, in which case it would be up to the attorneys, who may decimate the estate and fuel the fires to the interests of the attorneys and not the family.

I feel like it is a personal aspect in terms of being reasonable. If she chooses not to step up to the plate, than someone else will need to be paid to do so.  In this case, she would be paid for caring for her father through private resources and government programs.  This way everyone comes out better.