Hospice

Overview 

Hospice Care is provided to patients with terminal illnesses who are very near the end of life. Hospice Care does not focus on treating the illness or curing it, but rather on pain management, emotional support, spiritual support, and family support and bereavement. Hospice staff includes teams of physicians, nurses, personal care assistants, social workers, chaplains, and others.

Most Hospice Care is provided in the patient’s home or in a senior living community, though there are some residential hospice facilities. These facilities are meant to be homier and more comfortable than hospitals, though they are equipped to provide advanced medical treatment.

The Hospice philosophy is that death is a part of life and that it can be experienced best when surrounded by loved ones. Hospice Care is designed to lessen the traumatic response to death as it is experienced by both the patient and family.

Best Suited For

• A patient with a terminal illness who has received a prognosis of six months or less to live. 

• A patient with a terminal illness who may not have a six-month prognosis, but who has the financial ability to pay privately for Hospice Care for the duration of his illness.

Costs

If a doctor indicates that a patient is terminal with six months or less to live, Medicare will cover the cost of Hospice. If a patient lives beyond six months, he can continue to access his hospice benefit under Medicare if a doctor re-certifies the six-month terminal prognosis. Without a six-month prognosis, supplemental insurance, Medicaid, and some veteran’s benefits may cover the cost, or patients may pay privately. Costs average from $125 - $400 per day. However, check with your local hospice provider, as many offer some level of “free care” for those that financially qualify. 

Advantages

• Personalized care and emotional support through the last months of a person’s life.

• Personalized care focused on pain management, spiritual guidance (if desired), and death with dignity.

• Personalized bereavement services and emotional support provided to the family.

Disadvantages

• If you have no insurance means to cover the cost, Hospice Care can be expensive. There may be charitable funds in your area to cover the cost of care. Inquire with your local hospice organizations regarding this possibility.

Insider Tips: What to Look For                                                       

When your doctor makes a referral to hospice, the hospice staff will meet or communicate first with the physician to get the patient’s medical information, including  medical history, current quality of life, and life expectancy. After this meeting, hospice staff will meet with the patient and their family to discuss the option of using their hospice services. At this time, if the patient is for any reason uncomfortable with this hospice service, they can ask to be referred to another that serves that geographical area. You can locate different hospices that service your area on HospiceDirectory.org, or by calling the site’s toll-free number, 800.854.3402.

A physician’s referral is one way to access hospice care.  If your physician does not suggest this option, and you think it might be good for your family, just ask your physician’s office for a referral, or initiate the process yourself by contacting your local hospice care service. 

Continuing Care Retirement Communities (CCRC)

Overview

A Continuing Care Retirement Community (CCRC) is a senior living option that offers a continuum of care from Independent Living to Assisted Living to Nursing Care, all in the same facility or on the same campus. Residents enter into Independent Living and are guaranteed higher care should their needs change. This assures residents that they can age in place safely and comfortably within the same community.

CCRCs can be ideal for the right person, but they are not for everyone. They are expensive and require financial screenings. Potential residents must have sufficient income or assets to pay their monthly fees long term. Given the high costs, it is important to seek the advice of a trusted financial planner or elder law attorney before making this lifelong commitment. Also, potential residents are screened for medical issues and, generally, only relatively healthy people are allowed to buy into “life care” and “modified contracts” (see more in the “costs” section for explanation of these contracts).

Best Suited For

Individuals or couples with a higher income/assets who are capable of living independently (without assistance with Activities of Daily Living, ADLs), are interested in community living, and are focused on “aging in place.”

Costs

CCRCs generally involve a rather large buy-in fee to the community that pays for the home or apartment, and additional monthly fees that pay for the level of care they receive. There are three kinds of contracts:

Life Care or Extended Contracts have a high initial price, but guarantee that the monthly costs will never go up. Residents buy their home in the community (which may range from $150,000-$,500,000). In addition, they  pay a monthly fee (which may range from $1000-$3000 per month). This fully covers their care until they pass away, whether they remain in their home or spend their final years in Nursing Care or Memory Care. When residents do pass on, the home is sold and the estate is refunded most (between 80-90%) of the original purchase price. For those with the financial resources, this can be a great way to safeguard a portion of the estate for heirs, while guaranteeing care at a set price. Some Life Care Communities also have a policy that, if the residents become unable to pay their monthly fees due to financial hardship, the community will absorb that cost. This is not the norm, however, and most CCRCs have stringent financial requirements that potential residents must meet.

Modified Contracts have the same expensive initial buy-in but, in general, the monthly fees are not as costly as those with Life Care contracts. Residents start with relatively low monthly fees, which increase as care needs increase. Long-Term Care may be discounted for residents, and, in some cases, residents receive a specific number of days in long-term care free of charge. But when that time allotment expires, monthly fees may change radically. A person who pays $2000 per month while living independently may end up suddenly paying $7000 per month or more when they require nursing care. As with Life Care Extended Contracts, the home is sold when the resident passes away or moves to a higher care level within the community, and again, generally 80-90% of the purchase price of the home is refunded.

Fee-For-Service Contracts may or may not charge an entrance fee. If they do, it may be used to  pay for the cost of care that residents encounter as their needs change. These contracts generally charge market rates for their Long-Term Care; there are no discounts, and no amount of long-term care is free, unless specifically noted and covered by the entrance free.

Advantages

• Residents are guaranteed access to appropriate care when needed.

• Families and seniors have peace of mind knowing that, no matter what medical changes seniors experience, they will never have to move to a different community (although they may have to move rooms/buildings within the CCRC). This continuity of care can be a great benefit. 

• Contracts may have substantial tax benefits.

• Estate assets may be saved.

Disadvantages

• Upfront costs are substantial.

• Health and financial screenings may be required for potential residents, and the results may disqualify you.

• Community dissatisfaction - If you become dissatisfied living within the community, it may be difficult to terminate the contract because of the initial investment (though some CCRCs have policies in place to return entrance fees or some portion of the fees under certain circumstances).

Insider Tips: What to Look For

One of the most important things to consider when looking into Continuing Care Retirement Community is whether their continuum of care includes Memory Care. For example, a married couple came to us for advice and assistance after they bought in to a CCRC at a high cost and needed to terminate their contract when the wife developed dementia and required a type of care that was not available within their CCRC. The situation was particularly challenging because most of their assets were tied up in their CCRC home, and the community was not contractually obligated to refund any money until the home sold. Therefore, before the CCRC home was sold, the husband had to pay for her Memory Care at another facility, and he had to finance a new place to live himself. It was a very stressful experience for this family. Fortunately, we were able to help him achieve a sound solution, but it took some strategy. It is better to avoid this potential situation and choose a CCRC with Memory Care if this is an option available to you.  

Other life circumstances may arise where an individual or couple wants to leave the community. Before you sign, it is important to understand the process and policies on terminating the contract. Be sure to inquire about a refund on the entrance fee. Ask how money is refunded and under what circumstances. If any part of the contract is unclear, ask questions of the community’s liaison. You might choose to review the contract with your elder law attorney to make sure you understand everything.

Do some additional research to make sure a financially solvent company runs the community. When you or your loved one is looking at investing hundreds of thousands of dollars to enter a community, it is important that they have a sterling reputation and will be able to provide what they have promised, whether it be for the next five years or the next twenty. Find out how long they have been in business, ask to see financial reports, and check for lawsuits against the company.

When touring, speak to other residents and ask about their impressions of the facilities, staff, and social activities.

Nursing Care

Overview

Nursing Care Communities may also be called Skilled Nursing Facilities, Rehab, Long Term Care Facilities, Rest Homes, or Nursing Homes.  

A Nursing Care Community is generally the highest level of long-term care available to a person outside of a hospital. As opposed to Assisted Living Communities, where generally only custodial care is available, Nursing Care Communities have the licensure and qualified staff to assist with 24/7 medical needs, such as medication administration (including IV); insulin injections; physical therapy; wound care; management of ventilators/catheters/oxygen, and other assistive equipment; and assistance with all Activities of Daily Living (ADLs). Commonly there are some on-site activities to provide social interaction and stimulation.

Nursing communities can be divided into two categories: 

Skilled Rehabilitation: This is for short-term stays. It is an interim place for a person in need of medically supervised recovery from an illness, surgery, or injury. Medicare will help pay for skilled care under the right qualifications. Once a patient plateaus in their recovery and can be safely discharged, they return back home. If safely returning home is not viable, another care community, such as Assisted Living or Long-Term Nursing Care, may be needed.  

Long Term Care: This is generally for patients who have little expectation of returning to an independent lifestyle. A person transitions to Long Term Care when his medical needs require professional attention daily. Medicare will not cover the cost of Long Term Care. Depending on the state, and your individual medical and financial qualifications, Medicaid will help pay for Long Term Care.

Best Suited For

Seniors whose medical needs are so great that they require trained nursing staff for short term rehabilitation and recovery or long term care.

Costs

According to the Genworth 2012 Cost of Care Map: 

• National Median: $200/day for a semi-private room, $222 for a private room.

• Maine Median: $264/day for a semi-private room, $288 for a private room.

• New Hampshire Median: $270/day for a semi-private room, $288 for a private room.

• Massachusetts Median: $322/day for a semi-private room, $350/day for a private room.

The cost of Long Term Care may be supplemented by Long Term Care Insurance, Veteran’s Aid & Attendance, Medicaid (depending on the state and your individual medical and financial situation), or paid privately.  The cost of skilled Care may be supplemented by Medicare, your Long Term Care Insurance (depends on the policy), Veteran’s Aid & Attendance, and paid privately.

Advantages

• Qualified medical care with on-site doctor’s visits.

• Improvements have been made to standard of living in recent years.

• Covered by medicaid once senior qualifies for assistance.

Disadvantages

• Expensive if paying privately.

• Small or shared living quarters, which can feel like a hospital.

• Some seniors fear being “put in the nursing home.”  The transition can be difficult for the senior and the family.

Insider Tips: What to Look For

The federal government runs a website called Nursing Home Compare (http://www.medicare.gov/nursinghomecompare/) which houses information on all Medicare and Medicaid certified nursing homes. This site includes ratings on staffing, health inspections, and quality measures. It also provides detailed statistics on important information for each facility, such as the percentage of residents who got flu shots or suffered from urinary tract infections, as compared to the state and national averages. These details can be good indications of the quality of care.  

When doing research, Nursing Home Compare is a good place to start looking for facilities in your area. Once you identify communities that meet your needs on paper, it is important to visit those communities. Get a feel for each place and make sure that what you observe aligns with what you read. But please keep in mind that residents in Nursing Care Communities require a high level of medical support; the facilities often have the feel of a hospital in many respects. Be emotionally prepared for these visits and be realistic about your expectations.

When you visit, notice how the staff interacts with the patients. Do the patients appear well cared for? If you are uncertain about the interactions you observe and what they mean, do not hesitate to ask questions. In fact, asking the staff questions about how they interact with patients will give you a sense of their personalities and their professionalism. 

If possible, visit each location more than once at differing times so that you can see various staff members on different shifts. And when you visit multiple times, be sure to pay attention to the smell each time. In Nursing Communities, bathroom accidents happen. It is not rare to occasionally notice the scent of urine or other bodily fluids. When these accidents do happen, however, they should be cleaned up immediately and thoroughly. If you visit once and there is a smell, go back a second time and notice if the smell is still present. If the community is taking good care of facilities and residents you should not notice a consistent smell of bodily fluids each time you visit.  

There can be lengthy waiting lists for nursing communities. Therefore, it may be necessary to select several that meet your needs, since it might not be possible to have your loved one admitted to your first choice facility when the time that this level of care becomes necessary.

Memory Care

Overview

Memory Care within Assisted Living Communities provides dementia specialized assisted living care to meet the unique needs of people living with dementia, including Alzheimer’s Disease.  Sometimes care is delivered in a separate Memory Care specific unit within an Assisted Living Community; other times communities offer a Memory Care Program to residents who are mixed in with the general population of the community.

Memory Care units generally have smaller populations of residents and have a higher caregiver-to-resident ratio than commonly found in general Assisted Living settings. Also these units offer therapeutic activity programs specifically designed to support and nurture individuals with memory impairment. Many units are “secured” with locked doors to keep the residents from leaving the facility unattended. This is an important safety element for seniors with dementia who may have a habit of wandering or exit-seeking.  

Room types on Memory Care units vary from shared rooms to private studios (without kitchens). The communities have public areas and serve meals in a public dining room just like other Assisted Living Communities. Days are divided into regular schedules, and most of the resident’s time is filled by a meal or activity. Many have outside courtyards that are secure, but allow the residents to enjoy being outside and to get fresh air. Staff is available 24/7, but a nurse may not always be onsite.

Best Suited For

Seniors with dementia who need management, supervision, cueing, and who could benefit from therapeutic or socially stimulating programing. These seniors can usually physically perform some Activities of Daily Living (ADLs), but require reminders and cueing to do them. It is especially appropriate for seniors with a history or risk of wandering or for those who exhibit exit-seeking behaviors.

Costs

Memory Care programs cost roughly $700-$2500 more per month than a general Assisted Living Community. In New Hampshire, where the average cost of AL is $4,000 per month, you can expect Memory Care to cost roughly $4,700-$6,500 per month. In Maine and Massachusetts, Memory Care costs run roughly $5,200-$7,000 per month.

Advantages

• High Staff ratios and a well-trained staff that understands how to respond to the unique challenges of dementia. 

• A safe and sometimes secured (locked) environment, good nutrition, and medication management. 

• A consistent routine - often people with dementia experience less confusion and happier moods once settled into a routine.

• Therapeutic Activity programing that is appropriate for folks suffering from cognitive decline and who, despite this decline, deserve the dignity and respect that their age would otherwise command. Memory care staff are trained to provide that dignity and respect.

Disadvantages

• Expensive and the initial transition may be traumatic for the person with dementia.

• Some residents do not need secured locked doors to prevent wandering.  Some people might not like that doors are kept locked. 

• For people with early stage or moderate dementia, they may be at a disadvantage living in a community with residents with advanced dementia, and locked doors. 

Special Note on Memory Care in Nursing Communities

Secure Memory Care units or Memory Care programs within communities also exist in Nursing Care Communities. These programs are more appropriate for seniors whose behaviors require constant support and supervision, such as behaviors that threaten their safety or the safety of those around them. Alternatively, some seniors living with dementia require Nursing Care for unrelated chronic medical conditions and, therefore, are suited to Memory Care in a Nursing Community. 

In these units, individuals have less privacy and are more closely monitored than with any other care level. Doors and elevators are alarmed, and residents may have personal alarms on them to alert nurses if they attempt to leave or undertake a physical challenge that may be a danger to them, such as trying to stand, having forgotten that they have suffered from a hip injury. These units have frequent visits from specialists who are trained in addressing the residents’ psychological needs.

Insider Tips: What to Look For

Start by making a list of the medical, financial, and social concerns for your loved one, then add to that the questions you have regarding the community. Do your homework online first and find out as much information as possible regarding the reputation, state reviews, and ratings of each community.  

When you have narrowed your list, visit multiple residences for comparison. Ask to see the activity schedule, and ask what activities are catered specifically to the health of the patients’ cognitive function. If you are looking for a secured unit, ask what kind of security procedures are in place. It is ideal to find a setting  that also includes a secured outdoor space.  

Ask about available psychiatric services and speak with as many staff members as possible. This will help you get a sense of the professionalism and personalities of the staff. Ask about the type of ongoing dementia training the staff receives, as new developments in this field occur frequently. Also ask about the turnover rate of employees, as this gives you an indication of staff morale.

Memory Care is high in demand and low in supply, so availability can be scarce. As you plan, be prepared for waiting lists. As with all situations where cost and availability are significant hurdles, you may want to consider consulting a Senior Care Advisor to guide you through this process and help locate the best available care for your loved one.

Assisted Living

Overview 

Assisted Living Communities provide a range of care between Independent Living Communities and Nursing Care Communities, offering assistance with daily activities and custodial care, but offering limited or no medical care. This is a relatively new option in senior care. Thirty years ago there were only two options: living at home or transitioning into a nursing home. Assisted Living offers a more home-like setting than a Nursing Care facility. It provides as much independence as a resident can comfortably maintain, in a social setting, while still offering qualified support with the daily concerns of dressing, bathing, and meals, etc. 

Assisted Living residences vary in size and may be a studio, 1-bedroom or 2-bedroom apartments. Residents have access to common areas and daily activities, as well as meals served in a dining area. Depending on the community, transportation, housecleaning, and laundry services may be provided. 

The trend in Assisted Living is moving towards aging in place. Meaning, some AL communities have increased licensed nursing staff, and met higher licensing standards to be able to care for residents as their medical needs increase.  This allows age comfortable in place rather than transition to a Nursing Home.

Best Suited For

Seniors who need some assistance with Activities of Daily Living (ADLs), including seniors with dementia who may be able to physically perform ADLs but need cueing support to do so (note: Memory Care may be more appropriate depending on the individual with dementia). Depending on the state and licensure of the community, staff may be able to assist with medication reminders and other minor medical issues, and generally a nurse is on staff. But for those who require consistent medical assistance, an Assisted Living Community may not be suitable.

Costs

According to the 2012 Cost of Care Map by Genworth, the National Average is $3,000 per month; in Maine and Massachusetts the average is $4,500 per month, and in New Hampshire it is $4,000 per month. However, keep in mind these are averages. Meaning, depending on where you live these costs may be significantly higher.  For example, in Southern Maine AL communities tend to average closer to $5,500-7,000.  Whereas in rural Maine it can be less than $4,500. Depending on the state and the individual’s medical and financial situation, Medicaid may assist with the cost. Pricing structures are different in each community, most are month to month agreements. When you are comparing prices at different communities note that some will offer “all inclusive” pricing and others work on a rent plus services model. It can be very confusing, but be sure to understand both the move in price and what the price variation is for accessing more care or services over time. 

Advantages

• Great nutrition, socialization, wellness and activity programs, 24/7 staff for safety, peace of mind for family.

Disadvantages

• Expensive, small living quarters that may not provide desired amount of privacy; seniors may find the transition stressful or they may look at this as a loss of independence.

Special Note on Assisted Living in Maine

In Maine, our Medicaid is called MaineCare. MaineCare does cover the cost of Assisted Living if your loved one qualifies medically (determined by the state through the KEPRO Assessment) and financially, as set by financial criteria with regards to assets and income.  Accordingly, Assisted Living Communities can be categorized as those that accept MaineCare as the payer source, those that accept MaineCare as a payer source only after a minimum “private pay” period is met, and those that do not accept MaineCare and are private pay only.  

Be certain that before you get started in pursuing Assisted Living you know which category is right for you, both short-term and long-term.  It is advisable that you consult with a Senior Care Advisor if you are unsure. In addition to advising you on the right community for you, a SCA can advocate on your behalf, potentially leveraging what financial resources you have to help you access care that you otherwise would not qualify for. 

Insider Tips: What to Look For

Once you have determined that Assisted Living is the right option for your loved one, it is important to know how to choose the right community for his/her needs. There are many factors to take into consideration, including cost, location (see: Location Tips), and what the community has to offer in programing and services. 

Note that not all Assisted Living Communities are equal in the assistance they provide their residents, there are assisted living communities that require folks are able to ambulate and transfer independently (no wheelchairs) and others that provide up to a two person assist with these activities. One is not necessarily better than the other -- it depends on your needs which is better for you, so be sure to know the difference. 

Before you tour different communities, make a list of questions you want to ask. This list should include:

What activities are offered?

May I have a copy of the activity calendar? (When you look it over later, check for a for a combination of wellness, entertainment, game, and craft offerings. Compare this to other activity calendars). Can I attend some events as a guest?

How much assistance is available with ADLs? Is there a limit on the hours of care provided? 

What happens if my loved one needs more care?

Is transportation to and from appointments offered? 

How often are laundry and housekeeping services provided? 

How often do you have care plan meetings? 

Do you have a physician/geriatrician/psychiatrist that makes house calls to your community? 

If your loved one is incontinent or takes a high number of medications, explain her needs and make sure that the staff is able to provide an appropriate amount of support. Be aware that certain medical needs, such as insulin shots, may preclude your loved one from Assisted Living. 

Adult Day Programs

Overview 

Adult Day Programs are often hosted by Assisted Living Communities, Nursing Homes, Senior Centers, and other senior care related organizations. The programs offer supervised activities and social interaction for attendees, and some offer assistance with Activities of Daily Living (ADLs). Most programs are open Monday through Friday during business hours, although some have extended evening hours. Many offer transportation within a certain distance. The types of programs can be generalized as following:

Social: Provides meals, recreation, and some health-related services (like medication reminders).

Medical: Provides social activities as well as more intensive health and therapeutic services.

Specialty: Provides specialized services for particular needs, such as those with diagnosed dementias or developmental disabilities.

Best Suited For 

An Adult Day  Program is a great option for seniors living at home, either with family or independently, who could benefit from the structured socialization outside of the home, or for those who are unsafe alone at home while family caregivers are at work. Commonly these are seniors who need assistance or cueing with ADLs, but are healthy enough to commute to and from the program with transportation support.

Costs 

An Adult Day Program may cost $10-15 dollars per hour, or  $300-$500 per week for a five-day schedule. Subsidized programs are often less, and some programs offer scholarships. While Medicare does not cover the cost, for some it may be partially covered by Medicaid or Veteran’s Aid and Attendance Benefits. It can be a more affordable solution than moving a senior into an Assisted Living Community, and it has the added benefit of keeping a loved one in his/her own home or with family.

Advantages

• Social activity during the day, respite for caregivers, one or two nutritious meals daily.

Disadvantages

• Some programs have low attendance, may not provide transportation, and/or do not address the need for respite care during off-hours.

Insider Tips: What to Look For                                                                    

Depending on your location, you may only have one or two options for Adult Day Programs in your area. To determine whether your loved one is a good fit for a given program, determine what kind of personal support she needs.  Make a list of the challenges your loved one has - for instance, difficulties with medication management, mobility, toileting, eating, socializing, communicating, etc. Then be sure to ask the program representative about how they manage or support each one of these challenges. Inquire about transportation. If they do not provide transportation to your area, ask if they can refer you to a reliable, senior-friendly transportation service.  Visit the program to be sure it is a good fit. 

The National Adult Day Services Association offers a great deal of information in order to help you find and choose an Adult Day Center for your loved one, including a step-by-step guide to choosing a center. Visit their website at www.nadsa.org. 

Independent Living

Overview

On the spectrum of senior living options, Independent Living falls somewhere between Retirement Communities and Assisted Living in service offerings. Like a Retirement Community, residents live independently in small apartments or houses without assistance with Activities of Daily Living (ADLs). Often there are amenities such as restaurants, salons, libraries, and wellness centers onsite, as well as scheduled social activities. This makes them an attractive option for seniors who are no longer driving.

Some support systems are in place for those who may want assistance with light housekeeping, laundry, and/or meal preparation (usually only one meal per day is included, but there is the option of buying more meals). There is often a 24-hour staff member on duty in case residents encounter an emergency, and some communities have homes set up with emergency pull-cords or pendant monitoring systems in case of a fall.  

Independent Living and the level of services available may vary greatly from one community to another. In some cases, Independent Living Communities may be associated with Continuing Care Retirement Communities, where residents can transition from independent living to assisted living or nursing care within the same community as their needs change.

Best Suited For

Older couples or individuals that are relatively healthy and independent, but prefer the companionship, comfort, and safety of community living. The proximity to help in the event of emergency is paramount.

Costs

The range is $2,000 - $5,000 per month for rent, and additional services can have secondary costs. Sometimes it is based on a month-to-month lease. Other times IL Communities have a membership or “buy in” model that requires residents to put a large upfront deposit on their apartment or cottage and maintain a monthly fee that ranges from $1,000-$4,000 per month. When the resident either moves out or passes away, usually that original “buy in” is returned to their estate, less about 10%. 

This is can be a good deal for the right family, but be sure to make sure you understand all the rules about the money return. Sometimes there are delays that might effect you; for example, they may only return your investment when a new resident moves into your space. So if it takes them 6 months to get a new resident you might not get your money back right away. This is something you will have to consider if you need to transition into Assisted Living and you are counting on those assets to fund the transition.

Advantages

• Great amenities such as onsite pools, golf courses, gyms, and social activities. 

• Building and grounds maintenance are included.  

• Age-restricted communities ensure a quiet and calm environment - no noisy, late-night neighbors! 

Disadvantages

• Can be expensive when compared to non-community living, and the house or apartment sizes may feel small, especially for the cost. Not covered by Medicaid or long-term care insurance.

• Typically, no assistance with ADLs or help inside the apartment or home; it is common that residents eventually have to utilize a home care agency for personal care or medical help as their health declines, or they may have to move into an assisted living environment if home care is no longer financially or medically viable.

• Just like with Retirement Communities, your choice in Independent Living Community may come down to your budget. Finding the right balance between affordability and availability of amenities and support can be difficult, and it may require some compromise. 

Insider Tips: What to Look For                                                     

Since the level of service varies greatly from one Independent Living Community to the next, it is important to determine what your loved one needs in services and social stimulation before choosing a community. Independent Living Communities that closely resemble Retirement Communities may offer, for instance, no housekeeping, while those that offer more Assisted Living type services may not offer a full kitchen in the apartment.

Make sure the level of support offered in your community of choice matches the needs of your loved one. Specifically inquire about  meals, laundry, and housekeeping. Also, it is good to know if they have an emergency monitoring system is in place, and whether a nurse can be made available if ever needed. It is unlikely that a nurse would be on staff daily, but one might be available on call to residents.

Regarding social activities, ask if there are community events. Many communities will welcome you to attend a few events as a guest to see if it is a good social fit.  If you have family that visits from out of town, ask if there is a guest apartment available in the community.

If your loved one is unable to drive, evaluate whether the community setup meets her basic needs with onsite access to amenities and/or transportation to the surrounding towns. 

Retirement Communities (AKA 55+ Communities)

Overview

Retirement Communities offer a maintenance-free living situation with great amenities, and they also offer and a strong sense of community among peers. Generally, communities are age 55+, and can range in structure from mobile home parks to apartment/condominium complexes or to houses of all sizes.  

Some Retirement Communities center around a particular theme or passion. For example, you may find a Retirement Community for golf enthusiasts where the homes surround a golf course, or you may find an atmosphere where seniors are singing, playing instruments, or actually acting in a play.

Best Suited For 

Retirement Communities are best suited for older couples or individuals who are relatively healthy and independent, who are looking to downsize, and who enjoy community living.  These people ideally do not need assistance with Activities of Daily Living (ADLs) but if they do, they may be able to access assistance through a private agency. 

Costs

To rent: Most average $1,000 - $3,000 per month. To own: Typically start around $200,000+ (less for 55+ mobile home parks). 

In many cases, rent or community fees include access to scheduled activities, to maintained common areas (such as walking paths), and to pools and tennis courts. Although not standard, some may offer transportation or housekeeping services for small additional fees.

Advantages

• Great amenities such as onsite pools, golf courses, gyms, and social activities. 

• Downsizing living space to simplify housework.

• Building and grounds maintenance are included.  

• Age-restricted communities ensure a quiet and calm environment - no noisy, late-night neighbors!

Disadvantages

• Can be expensive and smaller when compared to a regular apartment or house.

• No assistance given with ADLs or housekeeping; residents may have to pay for a home care agency for personal care or medical help as their health declines, or they may have to move into an Assisted Living environment in another community if home care is no longer financially or medically viable. 

Insider Tips: What to Look For                                                        

Retirement Communities range from humble to luxurious. It is easy to become attached to a place or to discard a place based purely on aesthetics. You can avoid this trap by making a list of the amenities that are important to you and align those with your budget before you visit. Take the list with you and be sure to ask questions about each item on it. This will help you be realistic about what you can afford and will help you identify the most important criteria that will make you comfortable, happy, and socially engaged.   

Do not be shy about what you add to your list. If you love to decorate your home with Christmas lights in November, make sure you ask if there is a policy on holiday decorations.  If the community advertises that dogs are welcome, do not assume that your dog is welcome; make sure you ask if there are any restrictions on breed or size of dog. 

What is a Spend Down?

More on Medicaid

Reverse Mortgage

A reverse mortgage is a loan available to older homeowners. The loan is given against the equity in a house. It is not paid back until the homeowner sells the property, or it is recovered through the estate after the owner has passed away.  

For some homeowners, particularly those over age 62 who do not wish to pass down their home to children, this can be a good solution to finance medical and/or long-term care costs.

Is This a Good Option for My Loved One?  

There are many advantages to a reverse mortgage loan:

The homeowners get to stay in their home.

There is flexibility in the loan distribution: lump sum, monthly payments, a line of credit, or a combination of the above. 

The money can be used for anything, such as health care costs, home modifications, long term care insurance, mortgage pay off, or new car purchase. 

There are no payments to be made, as the loan is not paid back until the homeowners move and sell the home, or until the estate sells the home after the homeowners pass away.  

The eligible loan amount is calculated using a formula that factors the homeowner’s age and the value of the home. The lender will not lend more than the value of the home. 

Generally, the older the homeowner, the more equity he can access. This is related to interest. Interest accrues on a reverse mortgage just as it does with any other loan, which means that over time the repayment amount grows as interest compounds the original loan amount. Therefore the amount of equity lent is roughly the value of the home less the estimated interest. 

The interest is estimated based on the age of the borrower; the average amount of time before the borrower repays the loan decreases with the age of the borrower, which decreases the percentage of interest accrued over time.   

When the homeowner or the estate sells the home, the bank collects on the balance of the loan. If the home sells for more than the balance, the remaining money goes to the homeowner’s estate. So what happens in a bad real estate market and the home sells for less than the loan? If the home sells for less than the balance of the loan, the bank cannot collect any further. Reverse mortgages are non-recourse, meaning the bank cannot go after the estate or homeowner’s other assets.

By taking a reverse mortgage, you are not selling your home to the bank. Just as with a home equity loan, you are only putting a lien on the title. You may repay the loan at any time and maintain ownership of your property. Similarly, your heirs may choose to repay the loan after you have passed and maintain ownership. Unlike a traditional mortgage, you are not at risk for foreclosure, as there are no monthly payments to make. However, you do have to keep up taxes and insurance, and letting these payments lapse while you home is under reverse mortgage could have dangerous implications.  

Reverse mortgages are generally safe. Still, they should not be entered into without careful consideration and planning. Do some research and speak with reputable reverse mortgage specialists. The Federal Housing Authority has a reverse-mortgage program call Home Equity Conversion Mortgage (HECM). This may be the safest option for a reverse mortgage, but it does require that the homeowner carry FHA mortgage insurance in addition to home insurance.

There are scams to be aware of in the world of reverse mortgages. There have been documented instances of financial institutions lending a reverse mortgage for the purpose of financing the borrower to purchase a high-commissioned financial investment, regardless of whether or not it is the right choice for the homeowner. 

You should be skeptical of any financial advisor encouraging you to take a reverse mortgage to purchase a product from his firm or any other financial institution.

Are There Costs Involved in Reverse Mortgages?  

Yes, and the closing costs and fees of a reverse mortgage can sometimes be higher than costs associated with other options, such as a home equity loan. Before signing the contract, ask your lender about these fees and how you might be able to finance them into the loan. 

Veteran's Aid and Attendance

If your loved one or their spouse is a Veteran, they may qualify for VA Aid & Attendance or Housebound Benefits. To qualify they must meet specific criteria in three categories: service time, medical condition or age, and financial limitations.

Service Time

You must have been discharged in any fashion other than dishonorable. You must have served at least 90 consecutive days in the military and at least one of those days must have been in active military service during VA-defined periods of war. These periods of war may be found here: http://www.vba.va.gov/bln/21/pension/wartime.htm. There are some exceptions for Reservists and members of the National Guard. Inquire with the VA regarding your eligibility status if this applies to you.  

Medical Condition or Age

You must be age 65 or older and require assistance with Activities of Daily Living, or you must be permanently disabled, a patient in a nursing home, or be receiving Social Security Disability. It is a common misconception that a Veteran’s disability must be related to the service to receive this benefit.  

Financial Limitations

Your assets and your income must be under certain limits. This may vary depending on your marital status and your medical expenses. You may find out more information here: http://www.vba.va.gov/bln/21/pension/vetpen.htm 

The Basics of the Benefit:  Long Term Care Coverage

Aid & Attendance benefits, which pay for Home Care, Assisted Living and Nursing Care, need to be determined to be medically necessary on the basis of an individual’s inability to perform Activities of Daily Living; this determination will be made by a doctor. The application process is lengthy, and should be started as soon as this medical determination is made. 

In some cases it can take twelve months or more for the application to be fully processed. If the beneficiary meets qualifications, the benefit will be paid retroactively from the time the application was submitted; however, if the applicant passes away before the application is processed, the application will be cancelled and the benefit will not be paid retroactively to the heirs. 

The Aid & Attendance benefit amount will only pay for care costs that surpass the monthly income of the beneficiary. 

For instance, if the veteran has an income of $2000 per month from his VA pension and Social Security, but his home care costs are $3500 per month, the benefit will not exceed $1500 monthly. The maximum benefit is currently just over $21,000 per year for a single individual with no dependents. This money is paid directly to the beneficiary, who then pays the provider. In order to qualify, the beneficiary must have less than $80,000 in assets, not including their home, car, or annuities.

There is no “look-back” period in applying to the VA for benefits. This means that the VA will not inquire further into your accounts than the current statement.  

Assistance in completing the application is available from Veteran’s Service Organizations; however, if you have a complicated portfolio of assets, it is advisable that you consult with a financial advisor and/or Elder Law Attorney prior to submitting your application or making any changes to your loved one’s assets that may threaten your loved one’s Medicaid eligibility should Medicaid become necessary in the future.  

In some cases, receiving VA Aid & Attendance benefit has had the negative consequence of precluding eligibility for later Medicaid applications, especially in cases where a lump sum is paid out retroactively when the application is finalized. This is one of the many reasons that it can be helpful to complete financial planning with an Elder Law Attorney before the application is submitted, especially one who is accredited by the Veteran’s Administration.

Medicare Versus Medicaid

More on Medicare

More on Medicaid

More Topics about Paying for Care

Activities of Daily Living Explained

Activities of Daily Living (ADLs) are the basic activities of day-to-day living that one must complete to live comfortably and healthily. These activities include the following:  

Ambulating: Walking, with or without assistive equipment such as a cane or walker, or operating a wheel chair or motorized scooter.

Transferring: Transitioning one’s body position to ambulate. For example, standing up from a chair or getting from the bed to a wheelchair.

Toileting: Including the entire process of going to the bathroom, from needing reminders to initiate or to complete steps throughout the process, to needing physical assistance with pre or post bowel/bladder movement care. 

Feeding:  Physical capacity to eat meals, not including meal preparation.

Dressing: Including choosing appropriate clothing, and undressing.

Grooming: Including bathing, dental cleaning, and all hygienic self-care.

It is important to know and understand the Activities of Daily Living that your loved one has difficulty performing, and those which they need “cueing” with -- meaning reminders or prompts to complete the activity. 

Many providers and benefit programs use ADLs to evaluate the appropriate care level for your loved one, or to determine benefit eligibility. Medicaid, VA Benefits, and Long Term Care insurance all will require an evaluation of the beneficiary’s ability to perform ADLs. 

Aside from the Basic ADLs listed, there is a subcategory called Instrumental ADLs, which include matters like housework, money management, shopping, preparing food, driving, etc. 

These are important activities when considering quality of life, but are not typically considered when qualifying for benefits. 

They may, however, play a role in determining the appropriate care level when seeking out-of- home care, assisted living, or other care options. So be sure to list the activities that your loved one struggles with and keep this information with the other documents and papers.

About Medicaid

For many people who require long-term care, Medicaid is the only option for financing. Medicaid is a federally subsidized, state-run program providing health insurance to those who meet financial requirements, especially children, seniors, and the disabled. In some states, like New Hampshire, Medicaid is simply called Medicaid. In Maine it is known as MaineCare. In Massachusetts it is MassHealth.

For our purposes, we will be talking specifically about how Medicaid services seniors in need of long-term care. In order to qualify for this assistance, there are strict eligibility requirements, both medical and financial.

Medical Eligibility

To qualify for Medicaid coverage for Long Term Care, medical need has to be established. This is determined by assessing the need for assistance with Activities of Daily Living, medication management, or the degree to which cognitive impairment threatens safety. 

In Maine, the assessment process is conducted by the state Department of Health and Human Services (DHHS), which uses the KEPRO Assessment, formerly known as a GOOLD Assessment, to determine medical eligibility. In New Hampshire, the evaluation process is not an independent assessment, but rather a review of the senior’s documented medical history by a team of DHHS professionals. The review team carefully assesses physician’s notes and recommendations, and, in some cases, asks for additional examinations and testing. If you live in New Hampshire and you believe your loved one will need to apply for Medicaid, talk with your loved one’s physician openly and honestly about the challenges you have observed that he may not be aware of, as his support will be critical. 

In both Maine and New Hampshire, you have the right to appeal the decision if the assessment shows that your loved on is not medically eligible for Medicaid assistance. 

Financial Eligibility

Financial eligibility requirements vary from state to state. All states have asset limits that are generally very stringent. Middle class people are particularly vulnerable in this regard. In general, people in the middle class do not have the assets to pay for nursing care privately if it becomes necessary, but they have to go through a significant “spend down” of their assets before they qualify for Medicaid assistance. In the case of a couple, there is some protection of assets for the “community spouse,” meaning the spouse that remains living independently in their family home. Still, the provisions are not much and the spend down can be financially devastating.

In addition, some states also have income limits that can disqualify seniors from receiving Medicaid benefits. These kinds of limitations vary from state to state. To get a clearer idea of what the requirements in your state are, or whether you will have trouble qualifying for assistance, speak to an Elder Law Attorney, or contact a local Senior Care Advisor.

Non-Countable Assets

There are some assets that are considered non-countable or exempt in a Medicaid Financial application. These include the primary residence, household furnishings, wedding rings, vehicles, pre-paid funeral expenses, and businesses that still produce income. This is not a complete list, and again, this can vary from state to state. It is advisable to speak with an Elder Law Attorney about what is and is not a countable asset.

Look-back Periods and Penalties

When applying for Medicaid, a person’s finances may be subject to a “look-back” period. The length of this period varies from state to state. The purpose of this period is to prevent people from giving away money to children in order to shelter it from Medicaid. If any substantial amount of money is found to have been given away during the five years prior to the application, or any countable asset sold for significantly less than its market value, there is a penalty period. 

The penalty divides the amount of money given away, by a state-set nursing home monthly cost; the senior then becomes ineligible for Medicaid assistance for that number of months. For instance, if a senior gives their son or daughter $40,000 dollars within the look back period, and their state-determined nursing care rate is $5,000 per month, that senior becomes ineligible for Medicaid assistance for a period of eight months. This has become a widespread problem, as so many people engage in the practice of giving away money before death to avoid estate tax. 

Under certain circumstances, some asset transfers are considered protected. Be sure to check with a qualified Elder Law Attorney before making a significant transfer of assets.

Elder Law Attorneys & Medicaid Planning

Elder Law Attorneys are experts on the Medicaid requirements of the states they practice in, and they are the most qualified to assist in financial planning in terms of qualifying for Medicaid, whether it be in a crisis situation, during a spend down, or well in advance of needed services.  See the Elder Law Attorney section for more details.

Read More About KEPRO Assessments

KEPRO Assessments

Kepro Assessment (Maine-Specific)

A KEPRO Assessment is a necessary part of applying for MaineCare (Medicaid) assistance to pay for long term care. The process is performed by a Registered Nurse under KEPRO Health Systems, an independent corporation contracted with the state of Maine to medically evaluate if care is needed and at what level.  

These assessments were formerly conducted by a company called GOOLD Health Systems, so you may still hear people referring to them as “GOOLD Assessments.”

The evaluation is performed in the patient’s home, senior care community, or hospital room. The nurse asks questions regarding the senior’s ability to take care of himself, what kinds of medications he is taking, what kind of help he requires, and his income. Input from family caregivers is also considered. This is important because if your loved one has dementia, he may not be conveying an accurate account of his needs.

A KEPRO Assessment is ordered if there is a new MaineCare application, or if there is a change in the care level of a MaineCare-approved individual. An Assessment referral can be made by the care community where the senior resides, or by the family caregivers if the senior has not yet moved into a care community, but has a reserved an available spot. It is important to note, KEPRO will not complete an assessment unless there is an open space for the senior in a care community.

This can sometimes present a challenge for the family, as MaineCare facilities are often hesitant to hold a space for a senior unless MaineCare is already approved and MaineCare cannot be approved until the KEPRO Assessment is complete, which can take up to five business days. If you are working with a Senior Care Advisor, they can help you navigate this challenge. If you are working as your own advocate, the best approach, if you cannot hold a spot, is to confirm with the community that there is currently a space open should your loved one be qualified by KEPRO for that level of care. That will satisfy KEPRO; however, know that you should not let yourself get too attached to a particular option in a particular community because by the time KEPRO is complete, the space may be gone..  

KEPRO Assessments are only valid for thirty days. If you do not find a new space for your loved one in that time period, you will have to order a new Assessment. There is no fee for ordering a KEPRO Assessment. 

If your loved one will be using VA benefits, Long Term Care Insurance, or private assets to pay for long-term care, you will likely not need a KEPRO Assessment. However, some communities that accept both private pay and MaineCare require a KEPRO assessment, anyway, in order to assure that the individual in question will be eligible for MaineCare when and if their assets run out.

If you have questions about getting a KEPRO assessment or would like some input on how to prepare, contact us.

About Medicare

The first thing to understand about Medicare is that it does not pay for Long Term Care services, including Home Care, Assisted Living, Memory Care, or Nursing Care. This is a common misconception about Medicare, leading many people to believe they do not need a contingency plan in place once they qualify for Medicare.  

Medicaid is the federally and state funded program that helps to pay for long-term care under certain qualifications. However, not everyone who qualifies for Medicare also qualifies for Medicaid. Medicaid is only available to people who fall beneath strict asset and income limits and access specific medical care. These limits vary state to state, as does coverage. You can read more about this program in the Medicaid section.

Medicare is a federally funded health insurance program available to all people over the age of 65. It is also available to individuals younger than 65 with permanent kidney failure in need of dialysis treatment, or to individuals who are unable to work due to disability and meet specific criteria. It operates similarly to traditional health insurance, but there are no limits on pre-existing conditions. 

Medicare is broken down into many parts:

Part A provides inpatient hospital coverage, rehabilitation stays at Nursing Care Communities, and Hospice Care. There is no premium for individuals over age 65 who are receiving Social Security. If you are not eligible to receive social security, you may have to pay a premium.  

Part B covers outpatient care, primary care, and specialist care, as well as some additional services; e.g., mobility assistive equipment. Part B costs an affordable, subsidized premium, which commonly is deducted from your Social Security pension.  

Part C is called Medicare Advantage and is an optional substitution plan to Parts A and B. Medicare Advantage plans are run by private companies, but they are overseen and regulated by the government. They must include all of the benefits of A and B, but often include extra coverage for a higher premium; this may include prescription, vision and dental care. Out of pocket expenses may be lower with Part C plans.

Part D is prescription drug coverage. Like parts A and B, the government manages it, but it is voluntary to enroll.

You want to enroll in Medicare during the three months before you turn age 65 in order to ensure there is no delay in your coverage. If you miss this window, you may still enroll up to three months after you turn age 65, not including your birth month. In other words, if you turn age 65 in April, you may enroll, penalty-free, from January until July. If you do not enroll during this period you may have to pay a higher premium for late enrollment.  

Medicare also has a yearly open enrollment period that falls between mid-October and early December, though the exact dates change by year. During this time, you can make changes to your Medicare coverage. It is important to understand that Medicare is not one-size-fits all, and as you age and your medical needs change, you may need to change your coverage. 

Often, people are either under insured or over insured. To determine if you fall into one of these categories, get some assistance in evaluating your needs. Medicare.gov has a plan finder that can help you find what kinds of coverage are right for you, given your medical and prescription needs. Additionally, you can contact your local SHIP (State Health Insurance Assistance Program) for a referral to someone who is qualified to support you in figuring out what coverage plan is right for you. 

If you have questions about Medicare, please contact us. We will happy to answer your question by e-mail, or set up an office hour to sit down with you and discuss your questions.

Elder Law Attorney

An Elder Law Attorney is going to be a very valuable ally for you as you transition into a caregiving role for an aging loved one.

The best way to explain the value of an Elder Law Attorney, if you have not already experienced it, is to make an analogy. If you needed a heart transplant, you would not go to your family practice doctor. You would go to a cardiologist, who is an expert on the matter. The same can be said of general practice lawyers and Elder Law Attorneys.

While many think of retaining the services of an attorney to be something that only the wealthy do, it is often those in the middle class who have the most to gain from retaining the services of an elder law attorney. While those who have the fewest financial resources may access Medicaid right away, and those with extensive resources may never need it, those in the middle stand to gain a great deal from early planning in terms of an eventual medicaid spend down.

In matters asset preservation, estate planning, wills trusts and probate, Powers of Attorney and Advanced Medical Directives, and Medicaid planning, the stakes are high. You may find it is worth taking the time with an Elder Law Attorney to make sure that you do not make any costly mistakes.

For example, while general practice attorneys may know their way around asset preservation, they may not be knowleagable on Medicaid laws and regulations. The result could be asset preservation that incurs penalties if you later apply for Medicaid to supplement the cost of Home Care, Assisted Living, or Nursing Care.

You can find reputable Elder Law Attorneys through the National Association of Elder Law Attorneys.

If the cost of an Elder Law Attorney is outside your budget If this is outside your budget, contact your local Area Agency on Aging to findout if there are free Elder Law agencies or sliding scale firms in your area.

Maine: http://www.maine4a.org

New Hampshire: http://www.dhhs.nh.gov/dcbcs/beas

Massachusetts: http://www. cityofboston.gov/elderly/agency.asp

Guardianship

A guardianship is a legal right given to a person to be responsible for the food, health care, housing, and other necessities of a person deemed fully or partially incapable of providing these necessities for himself or herself.

Establishing Guardianship is a court process which is a great deal more costly and complicated than establishing a Power of Attorney. A medical evaluation of competency is legally required. The senior must be determined medically incompetent. This process is emotionally draining for the senior and his family. After the incompetency is determined, the person seeking Guardianship must go before a judge to declare the incompetence and petition for Guardianship. The court
date is announced and all family members will be informed and invited to contest, whether or not they have a meaningful relationship with the senior in question. The senior may also contest the proceedings.

It is recommended to avoid Guardianship to the best of your ability. Investing the time and money to consult with an Elder Law Attorney to draft an airtight Power of Attorney document early, and before a crisis hits, ismuch more cost effective and may save a family a significant amount of emotional hardship. When Guardianship cannot be avoided, seeking the advice of an elder law attorney is appropriate.

How to Choose a Power of Attorney

Who should you trust with your POA? It does not necessarily have to be the family member or friend with the most health care knowledge or the most advanced understanding offinances.

It is not wise to name a person as POA just to spare hurt feelings. For example, in a family where there are four adult children, the temptation is often to name all four children as POAs
so that everyone has fair say, but this can complicate decision-making in the future when family dynamics come into play.

The best course, usually, is to choose two loved ones (one as the primary agent and one as an alternate) that you trust to keep your best interests at heart. You may grant both financial and medical powers to the same agent, as medical and financial decisions will overlap frequently. If you choose different individuals as financial and medical POA, be sure to choose individuals who work well together, as frequently they will have to agree mutually on decisions.

While you do not need a financial wizard or a medical pro as your POA, you do want to consider the capabilities and personalities of the people you are designating. Someone who has poor history with money management, or has been unable to keep her own paperwork organized, is probably not the best choice for Financial POA. Someone who may be too emotionally frail to make difficult decisions surrounding death is not necessarily the best choice for Health Care POA. You will also be required to name an alternate for each position, a person that can take over the responsibility ifthe first person refuses, becomes incapacitated, or dies.

If you cannot name family members or close friends, you may name an accountant, attorney, or another professionalto be your financial POA. In this case, there will be a schedule of fees associated with the service. Compensation is decided between the principal and the agent, If you wish, family and friends may also be compensated for their service as your agent.

What if a person becomes incapable of making financial or health care decisions for themselves, but they have no POA agent? What if your agent is deceased and the backup refuses? What if the agent was your spouse, but you since divorced and never updated the document? In any of these scenarios, an agent will have to be granted Guardianship, since cannot establish POA for a person who is cognitively incapacitated.

Click Here to Read More About Guardianship

Understanding Powers of Attorney

When you begin taking on the role of caregiver to an aging adult, your first step in the process should be to consider your loved one’s Power of Attorney (POA). If your loved one does not have a Power of Attorney in place, or if it needs to be updated, you need to establish this vital document.

A POA is a document in which an individual (known as the “principal” or “grantor”) names another person or multiple people (the “agent(s)” or “attorney(s)-in-fact”) as decision-maker(s) on behalf of the principal. This document is essential to handling your loved one’s financial and medical affairs.

Executing a POA does not require that the principal be cognitively incapable of making decisions;
it simply allows another person to act on the principal’s behalf. For example, a principal may be hospitalized for a brief time and need an agent to access bank accounts to pay bills. As long as the principal is capable of making decisions, the agent must follow her directives. A POA can be revoked at any time should the principal become dissatisfied with the agent’s actions.

There are different types of POAs. Some “General” POAs expire when the principal becomes cognitively incapacitated; if the principal can no longer make decisions, the agent’s Power
of Attorney is revoked. When establishing a POA for a senior, a “Durable” POA is recommended. This POA allows the agent tomake health care or financial decisions for the senior if they become incapable of making these decisions for themselves.

In some states, Durable Power of Attorney can be “springing,” meaning that the named agent does not acquire Power of Attorney until the principal becomes incapacitated. The definition of incapacitation can be customized within the document when written by a qualified Elder Law Attorney in the state where the POA will be executed.

Principals may designate different individuals as Financial POA and Health Care POA. Financial POAs empower agents to handle financial transactions, such as managing investments, depositing checks, paying bills, and completing tax returns. Health Care POAs make medical and care decisions, such as treatment decisions and accessing long term care benefits.

In both cases, the agent is the fiduciary of the principal, meaning they are legally obligated to act loyally and with the best interests of the principal in mind, honoring their wishes and preferences whenever these are known.

In the case of a medical power of attorney, it is generally wise for an individual to create a health care advanced directive at the same time, making known their wishes for life-prolonging treatment or end-of-life care in the event that catastrophic illness or injury prevents them from communicating their wishes later. This includes statements regarding resuscitation, life support measures, as well as services for spiritual counsel or prayer. Many states allow a medical power of attorney and a health care advanced directive to be in the same legal document.

There are forms available online that make it possible to create a POA without legal advice or help. Though this could be better than not doing it at all, given the sensitivity and vital importance of the POA content, it is recommended that you consult with an elder law attorney.

Click Here to Read “How to Choose Power of Attorney”

Click Here to Read About Guardianship