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I’m scouting nursing homes for my mother, who has Alzheimer’s. Can they ever kick her out if she runs out of money? ? | Chicago, Illinois Elder Law Attorney Anthony B. Ferraro

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July 25, 2012

- Alzheimer's Care, Blog, Elder Law Articles, Medicaid and Paying for Nursing Home Care

This is a good question that you need to sort out before making a final decision about specific living arrangements for your mother. Medicaid is for individuals who have little or no means to pay for their own care. Eldercare facilities must be certified by the appropriate government entities to serve Medicaid beneficiaries. Some nursing homes and other eldercare facilities simply are not certified to accept Medicaid funding once a resident runs out of his or her own money. And those facilities that do accept Medicaid could have a long waiting list for the beds designated for that type of care. That is why it is so important to figure out the lay of the land and your options before you initially settle your mother into a facility. Find out the monthly cost of a nursing home that interests you and project how much you think you will ultimately be needed. If you think your mother will outlast her funds, you can ensure you choose a provider that will accept Medicaid, when and if the need arises. Families of individuals with Alzheimer’s usually do not want to move their loved ones if they don’t have to, especially not after they have adjusted to their surroundings. Changing locations can be very stressful for a person with dementia.  To learn more about Medicaid, click here.
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The nursing home changed my father’s medications and now wants to evict him and have him checked him for possible inpatient admission because of aggression. Should I have him assessed if the odds are he won’t be taken back by this facility?

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June 29, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Extreme agitation is typically the source of aggression. If the agitation is under control, the aggression should lessen, if not stop altogether. If you believe the nursing home’s staff members did not handle this the best way possible, you can meet with the facility’s director of nursing and the care-plan team to discuss the situation. If that doesn’t bring satisfaction, you can take it further, to the state’s long-term care ombudsman program. Ombudsmen are trained volunteers who, upon request, advocate for nursing home residents and their families when there are problems with a facility. If you are confident that staff members did all they could, your father needs to be assessed. Outbursts of aggression are not only difficult on the people around the Alzheimer’s patient, but also on the individual himself or herself. There is little quality to life when one is agitated all the time. There are various good assessment programs throughout the country. You can learn about some at the Alzheimer’s Association website (www.alz.org). Look for a program near your area. One good thing about an inpatient assessment is the 24-hour-a-day observation. Its value is evident because there can be additions, deletions or changes to medications — and observation of any effects of these changes. You could learn that his medication is causing his agitation. Be sure to keep his doctor informed of what you’re doing and what is happening. When he is being assessed, you have an excellent opportunity to meet with discharge coordinators or social workers. They can help you find the right facility. They may not recommend any one facility but they can give you guidance. Another thing to remember is that environment can play a huge role in how comfortable a person is. If your father is not comfortable where he is, a move might be the best idea for him. Even though moving a person with Alzheimer’s can create confusion and possibly setbacks, the odds are he will recover. Your father needs an environment that feels loving and accepting to him. Staff members are usually the key in this regard. So if/when you wind up looking for another nursing home, be sure to meet staff and observe their interaction with residents. Additionally, if your father didn’t live on an Alzheimer’s unit before, look for one now. Their staff members are specially trained to deal with symptoms and issues that accompany Alzheimer’s.    
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How beneficial can I consider a dementia care unit for my mother?

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June 27, 2012

- Alzheimer's Care, Blog, Elder Law Articles

If it’s done well — with proper staffing and development — it can be very beneficial. The idea of the dementia care unit is to provide specialized care, which includes trained staff for dementia, smaller units to soothe residents’ feelings and a locked area that will be safe for those who wander or pace relentlessly. The last two are symptoms that most Alzheimer’s patients experience at one time or another. Dementia units do not try to stop it from happening but rather aim to contain it to a safe environment. If your mother lived in an open facility — not a specialized unit— she might become more confused. Many such facilities are larger, have wide open spaces and high ceilings, and a lot more people coming and going. Those conditions are virtually eliminated in a special care unit. Dementia units raise the level of care while lowering the levels of stimulation. Many have done away with overhead intercoms since they can cause serious confusion or agitation for residents. The standard for Alzheimer’s care in most facilities is that the special unit has its own activities director. Often, direct care staff also are trained specially to participate in resident activities, which are specifically geared to the residents’ needs. For more information on special Alzheimer’s care facilities in your area, contact your state’s Department on Aging. It can give you a list of units or tell you where you can find one. If you have the option, visit at least three of these units in your area before making a choice. As always when visiting a potential home for a loved one, take someone you know and respect who preferably isn’t in the family. That way you can get a more objective view of what’s going on. Meet the staff and observe how they treat the residents, and how the residents respond. It’s not unusual for a facility to have a few deficiencies, but how serious were they and have they been corrected in a timely manner? You need to know these things. When you make a decision about a facility for a loved one, listen to your gut feeling. It is often a very accurate way to gauge. You still need to take stock of basic needs and questions; talking with the person who accompanied you on your visit will help sort things out. Then you can make a rational decision that everyone can live with more comfortably. For more information regarding Alzheimer’s, click here.
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Are group homes appropriate for individuals with Alzheimer’s disease?

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June 25, 2012

- Alzheimer's Care, Blog, Elder Law Articles

States use different names for residences like these, which may have four or five people each. In some states, they are referred to as boarding-care homes. Some states license them and some do not. You should call your state’s facility licensing agency and ask. You also can inquire about getting a list of them. Look for homes like this, which are specifically designed to help people with Alzheimer’s or other dementia. Typically, staff there will be specially trained to work with such individuals, and keep everyone safe. If there isn’t a facility like this near your home, you might want to reconsider pursuing such living arrangements. One of the considerations for this type of living arrangement is whether your loved one can live out the rest of his or her life there. What happens if he or she runs out of money? Does the place accept Medicaid? Can he or she stay if she becomes bedridden, needs incontinence care or needs a wheelchair? With regard to dementia care, sometimes the smaller homes are ideal because they feel more like home, not an institution. The facility manager can keep a closer eye on things, though the appropriate employees still need to be hired and trained. Smaller homes like these typically have staff members cross-trained; they might be personal care assistants, as well as cooks and cleaners. You’ll want to observe at any home like this you may be considering whether residents have a daily schedule and routine. Some tasks might need to be modified to take an individual’s level of functioning into consideration. But by and large, residents can assist with things such as preparing meals, setting the table, folding clothes and towels, sweeping the floor, watering plants, helping in the yard, taking out the trash, and numerous other tasks. Allowing residents to help with daily chores makes it feel more like a family environment for everyone. This will be a community of its own for your loved one. It should be a place where he or she will make friends and have other caring individuals around.  For more information about Alzheimer’s click here.
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Could my loved one actually be happier at a nursing home?

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June 20, 2012

- Alzheimer's Care, Blog, Elder Law Articles, Medicaid and Paying for Nursing Home Care

Yes. Many people are happier at a nursing facility, for a variety of reasons. First of all, nursing home residents have decreased feelings of intimidation because they are surrounded by others who similarly have decreasing abilities. Also, the intimidation of being in one’s own home but being far less able is taken away. Some view a nursing home like a specialized college dormitory. Each resident has his or her own living space, plus access to common living areas. There are good opportunities for social interaction in places such as the dining room or TV lounge. Even individuals who were not particularly social earlier in life usually enjoy socialization at this point. A good eldercare facility also offers daily activities. There typically is enough variety to have something that meets the needs of almost everyone. There can be group activities such as bingo or book clubs. There might be reading or jigsaw puzzles that can be made. If a favorite activity is not offered, a facility often will make an attempt to add it, as long as staff members know there is interest in it. Throughout, residents are monitored by nurses and nurse aides. Another plus is that a facility doctor is available, at least by phone, to answer questions and write orders as needed on a personalized basis. Realize that once someone enters a nursing home, he or she may still leave for short trips or overnight stays with family or friends. If there is dissatisfaction with a certain facility, a transfer to another facility is always a possibility. It’s you and your loved one’s choice — always. Being in a nursing home also can increase feelings of independence for an individual. How? A nursing home is a safe, secure place with care around the clock, good hot meals, socialization aspects usually not found at home, and activities available all day. Residents who might have felt they were a burden to their families can find some sense of comfort and satisfaction that they can live “on their own” and not be such a strain on their loved ones.  
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How do I pick the ‘right’ nursing home or assisted living facility for my loved one?

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June 18, 2012

- Alzheimer's Care, Blog, Elder Law Articles, Medicaid and Paying for Nursing Home Care

Be aware that you can narrow your choices by location and by whether they offer specialties such as Alzheimer’s and dementia care — at both assisted living and skilled nursing facilities. You can get a list of facilities from the Alzheimer’s Resource Center, Alzheimer’s Association, Area Agency on Aging or various telephone directories. Check out facilities that interested you in your area before your family needs one so you can make a decision under less stress. Take notes on several facilities so you can comparison shop because that is exactly what you’re doing: scouting out some of the most important services you may ever need. Make a few visits, and make them at different times of the day. Take someone you trust with, preferably not a family member, as this type of person will be more objective and see things in a different light. Gauge the atmosphere of the facility. Is it warm and inviting? Does it pass the “smell test”? How do staff members interact with residents? Are they treated with respect? Are they attended to promptly? Is the facility clean, both inside and out? Are there secure outdoor areas intended for resident use? Is administrative staff available? Does it seem like a friendly facility? Ask for at least three names and phone numbers of families you can talk to who currently have a resident at the facility. Ask around in the community about the reputation of the facility. Any nursing home you visit must have readily available the results of its last state survey (inspection) so don’t be afraid to ask to see them. Or check out the Nursing Home Compare website that the government publishes precisely for this use. Once your loved one is admitted, your responsibility for checking out a facility is not over. You can stay as involved as you want, and you should keep as prominent of a presence as you wish. Research has shown that proximity is the top reason most families choose a certain facility. This means visits should be convenient, and possible for other family members and friends. Use visits — by any others — to serve as check-ups on living conditions for your loved one. Although there are more and more Alzheimer’s-specific facilities opening, it is not uncommon for them to have waiting lists. It can be months before a spot opens up, so if you’re at all inclined, go ahead and put your loved one’s name on a waiting list. If you are called about a vacancy and aren’t ready for the move yet, tell them. They are usually more than willing to put you back on the list, farther down, and they will call again. For more information regarding Alzheimer’s, you can click here to view the Alzheimer’s Resource Kit.
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How do you know when it’s time to start nursing home care?

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June 14, 2012

- Alzheimer's Care, Blog, Elder Law Articles

The top desire of most people — Alzheimer’s patients or not — is to keep a loved one at home for as long as possible. Each caregiver and each person has a different threshold for what he or she can deal with (and survive with) at home. For example, if incontinence is involved and a person can’t go to the bathroom on his or her own, a caregiver might think it is almost automatic that nursing home placement is necessary. Other issues involving “activities of daily living,” such as eating, dressing and wandering, or behavior or wandering issues, might worry caregivers, too. Sometimes caregivers think they have reached their limit but then realize things aren’t as bad as they first think. This is often the case if they have taken steps beforehand to pre-arrange help. Being prepared and pro-active will lower stress and worry, and likely put off facility placement, for at least a while. Whether to keep a loved one at home or in a nursing home is a very personal choice. Most caregivers want to keep their loved one at home as long as possible; most individuals agree with this philosophy. But keeping a person at home isn’t always the best choice. Nursing homes are a needs-based service and there are very real reasons people need to be there. Moreover, nursing home placement may be necessary for the caregiver’s health. If you are the primary caregiver and someone you respect voices concerns about your health, you should listen with an open mind. Many caregivers are too close to a situation and do not view things rationally or objectively. It could damage their health. There are numerous senior service agencies around to help with the decision about nursing home placement. Get a list of options soon after you receive the Alzheimer’s diagnosis. This will help you be more comfortable, by planning and being more proactive, rather than being unprepared and uncertain during what could become a crisis situation. Dealing with a loved one with Alzheimer’s is a daunting task. There’s no need to tackle it alone, however. An excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.
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When should I start looking for a nursing home if my father has Alzheimer’s?

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June 13, 2012

- Alzheimer's Care, Blog, Elder Law Articles

You should start looking as soon as you are comfortable — realizing that it will almost always be difficult. Proper advance planning will help prevent or lessen a crisis situation later. Maybe you’ll never need the services of a nursing home, but it pays to be proactive and check them out anyway. Making decisions in crisis mode is much different than being able to plan ahead more calmly and thoughtfully. Local elder law firms, the Alzheimer’s Association, hospitals and other healthcare providers, the Area Agency on Aging and stage regulatory departments can be good sources for lists of facilities. When you visit a facility, take someone with you so you get more than one perspective. It also helps to have someone removed from the situation who can be more objective and might notice things that you don’t. Ask facility operators if they offer short-term respite care. That might be what you need to start with — or it might be the only thing you ever need. This can allow you a break if you get sick or need to go out of town, for example. If you have an unexpected situation that takes you out of the picture, you will have plans, and lowered the stress levels for you and everyone around you. Dealing with a loved one with Alzheimer’s is a daunting task. There’s no need to tackle it alone, however. An excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.
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I’m the primary caregiver for someone with Alzheimer’s … How can I get a break?

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June 4, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Alzheimer’s is a family disease, so that means it affects everyone. Primary caregivers in particular experience a lot of stress. For this, the first steps are acknowledging it and getting help.   Take advantage of the generosity of any family members or friends who are willing to help out. If you’re one of the many family-member caregivers who don’t have this type of assistance available, look to any of the increasing home- and community-based services that can help afford you a break.   Look for these services nearby:  
  • Adult say services — Clients actually go to these centers for socialization, stimulation and supervision while primary caregivers get a break. Not all centers have experience caring for Alzheimer’s patients so check around.
  • Overnight respite — Many nursing homes and assisted living facilities offer short-term stays with the express purpose of giving caregivers a break. Most do it on a space-available basis, though, so you need to plan and have a calling list ready.
  • Hired caregivers — You can hire a live-in caregiver. Networking can be helpful here. Ask around church or other local groups, such as the Alzheimer’s Association or the Area Agency on Aging, for experienced caregivers who typically work on an independent basis. If no agency is going to be responsible for these caregivers, you must treat this process with the diligence of hiring an employee (which is, in fact, what you’d be doing). Check references, do a background check, get to know the prospective caregiver, see how she or he interacts with your loved one, and don’t be afraid to ask the candidate back to check interaction a second time. You should ask your loved one for input about the candidate. Sometimes people with dementia have keen senses of perception and intuition.
  • Private duty home care — This is for single services or groupings of them on a spot basis. Many agencies offer workers who provide these types of services, which can include bathing, taking to appointments, shopping, sitting, meal preparation and other day-to-day needs.
  But again, it can’t be emphasized enough: If you have family members, friends or others you trust who are willing and able to help, use them.
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Medicaid Reform Again, But WORSE!

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May 25, 2012

- Blog, Elder Law Articles, Estate Planning, Medicaid and Paying for Nursing Home Care, Probate, Estate, and Trust Administration

The SMART Act SB 2840 will reverse many of the DRA changes Elder Law attorneys fought for on behalf of our clients.  The changes include the following:
  • Legal fees are no longer exempt for 3-month backdating.
  • Abolishes spousal refusal entirely.
  • A homestead in Trust is no longer an exempt asset.
  • Except for the Community Spouse Resource Allowance ($109,560) and Minimum Monthly Needs Maintenance Allowance ($2,739, HFS is no longer limited in how much it can seek when pursuing a support order against a community spouse.
  • Reverts to the old limits on prepaid funeral contracts.
  • Reduces the home equity exemption to the minimum allowed under federal law (base figure of $500,000, adjusted annually for inflation, rather than the $750,000 adopted in the DRA rulemaking).
  • No exception for prepaid funerals for 3-month backdating.
More to come.
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