48 THE QUEENS COURIER • HEALTH • SEPTEMBER 5, 2019 FOR BREAKING NEWS VISIT WWW.QNS.COM
health
Elder Law Minute TM
Planning for Longevity and the Rising Cost of Nursing Home Care
ELDER LAW
Assessing the Situation and Aging
John is an independent, proud-eightyyear
old man who had nursed his late
wife through her long bout with advanced
Alzheimer’s disease and kept her at home
until the very end. When friends and family
wondered how he did it, given his limited
mobility due to crippling arthritis, he would
say, “I would have it no other way.”
Not only did he insist on doing his own
shopping and cooking, he also shopped for
neighbors in his apartment building, whom
he characterized as the “old folks.” But when
John had a stroke which paralyzed his left
side, there was no way he could return
home from the hospital. John and his three
children were told by a hospital representative
that they had a week to fi nd a skilled
nursing facility for him.
Th e agonizing decisions which John was
facing are the same that numerous older
adults and their families will encounter.
Th is is an eventuality that most of us dread
and for which few of us plan.
John’s children love their father and want
the best for him, and they are deeply troubled
by the decisions they must now make.
Placing a loved one in a long-term care
facility is painful because it forces us to face
the irreversible deterioration of someone
we love, as well as our inability to care for
that person ourselves.
Religious tradition teaches us that we
are obligated to honor and revere our parents
to ensure that their basic needs are met
and that they are treated with dignity and
respect. However, we also recognize that
we have competing responsibilities, or that
there may be very real limits to our ability
to provide care directly for aging parents
who may have signifi cant physical or mental
impairments. Fulfi lling our obligations
to a loved one sometimes means fi nding the
right person and the right setting to care for
them, when we cannot.
Th e fi rst step before considering longterm
care, is to make sure your loved one
has been thoroughly assessed for needs,
resources and available alternatives. For
instance, you may want to have him medically
assessed to determine whether the
incapacity is likely to be temporary or permanent.
You will also want to consider what
level of care is needed and in what setting.
Th e theme is to investigate and then
choose a facility, whether it be home-based
care, personal care, assisted living or longterm
care.
Choosing a nursing home requires that
you choose carefully. To start, get referrals
from friends, neighbors, or a social worker
and once you have identifi ed a few places,
you will want to visit them. As you look
at a facility, carefully evaluate its physical
environment. Look not only for cleanliness,
but to what extent it seems “institutional.”
Be alert for what you can discover about
the atmosphere and its surroundings. For
example: how are residents addressed? Do
staff use the term “Pop” for an elderly man
instead of his name? Is their privacy with
dignity and freedom to move about unhindered?
As you make the decision as to where
your loved one will reside, involve everyone
who will have to live with the consequences.
By that I mean siblings who are
geographically distant from you. It is worthwhile
to give them information about any
and all options and to solicit their input.
Remember that the most important person
in all of this is the resident who will
live there.
It is vital to involve that individual in the
decision-making process to the maximum
extent possible. If he is not able to visit that
facility personally, try to show photos or
brochures to him.
As you help the resident move into a care
facility, be aware that leaving home involves
signifi cant loss, emotionally as well as physically.
Allow for a meaningful transition
from home to facility to make the moment
by letting him supervise those decisions
about what to take, what to give away, and
to whom things should be given. Make sure
your loved one brings treasured mementos
with him. Bring objects that refl ect something
about who he has been.
According to the researchers, Silverstone
and Hyman, they state the following in
their book You and Your Aging Parent,
“Institutionalization, although a tragic step,
Dr. Sheldon Ornstein is a
registered professional nurse
with a doctoral degree in nursing
organization. He has specialized
in the care of older adults and has
published many articles on the
subject. He has done post-graduate
work in gerontology and has
taught at several universities. In
2013, he was inducted into the
Nursing Hall of Fame at Teachers
College, Columbia University.
is not tantamount to dying.”
Here are some fi nal thoughts. Although it
is diffi cult at best, you can help your loved
one adjust to care in a facility by visiting
regularly, which can boost his spirits, especially
if you can fi nd things to do together
that he particularly enjoys. You can also
help by forging a positive alliance with the
facility staff . You can help the staff to appreciate
what’s special about this resident by
telling them about his past and his accomplishments.
Remember, entering a nursing home does
not have to be the “end of the line.”
Victor Frankel, a well-known psychoanalyst,
recounts his concentration camp experience
in his epic book entitled Man’s Search
for Meaning, with the following, “We can
fi nd meaning even amid suff ering through
our deeds, through encounters with others
and through growing and changing.”
Sheldon Ornstein Ed.D, RN, LNHA
BY RONALD A. FATOULLAH, ESQ.
AND ADAM D. SOLOMON, ESQ.
Th e rising cost of nursing homes, and
thus nursing home care for our loved ones,
is an epidemic that has become an all
too present reality for many in the United
States, especially in New York. In fact, a
recent study conducted by the Georgetown
University Medical Center and health policy
researchers found that the rising cost
of nursing home care is far exceeding the
rate of infl ation and that nursing home care
“is arguably the most signifi cant fi nancial
risk faced by the elderly without long-term
care insurance or Medicaid coverage.” With
many nursing homes in the area charging
in excess of $500 per day, many individuals
will undoubtedly fi nd nursing home care,
and their ability to pay for same out of their
own pocket, to be simply unaff ordable.
Nursing home care and long term care
coverage are not issues solely reserved for
the elderly or one with which only baby
boomers nearing the next stage of their
lives need be concerned. Rather, the cost of
growing older for all individuals, and the
place where many of us may spend the last
several years of our lives, must be factored
into everyone’s estate plan. It is never too
early to begin planning for one’s longevity,
but it is certainly a must for anyone considering
retirement within the next fi ve to
ten years. Failing to plan for the exponentially
rising costs of nursing home care and
long term care coverage will cause many
individuals to fi nd their hard-earned nest
eggs depleted by having to privately pay for
these costs out of their retirement and savings
accounts.
Using a lower average rate of $441 per
day for the cost of nursing home care on
Long Island (as estimated by the New York
State Department of Health), such cost will
still exceed $160,000 per year, which an
individual in need of nursing home care
will be required to pay out of his/her own
bank account, absent a proper estate plan
and coverage. Such costs can wipe out the
retirement savings of many individuals and
severely lessen, if not altogether extinguish,
any future savings which one may otherwise
have enjoyed or legacy which one may
have wished to pass on to surviving family
members, friends or charities.
Many individuals believe that Medicare
will protect them in the event that nursing
home care is needed; however, Medicare’s
coverage of nursing home care is quite limited.
Medicare may only cover the fi rst 120
days of one’s fi rst spell of illness, but what
then? What if the individual needs additional
coverage? Th e fact is that the individual
may be required to pay the bill of at least
$14,000-$20,000 per month. For those without
such savings, it is still possible to protect
one’s hard-earned savings. One option
is for an individual to procure long-term
care insurance. While the premiums may be
costly, it is hard to place a price on peace of
mind. (However, the younger an individual
is when purchasing a long-term care policy,
the less expensive such a policy will likely
be.) Another concern is that a long-term
care policy may not cover the full cost of
nursing home care or long-term care coverage,
which would then require the individual,
depending on the policy, to expend the shortfall
remaining from his/her personal savings.
Still, not everyone will qualify for a long-term
care policy or be able to aff ord the premiums
– especially with the premiums increasing
with infl ation, both with and absent a supplemental
rider insuring against same.
Medicaid, which is currently the only governmental
insurance program that covers
the cost of long-term care, is a means-tested
(asset based) program, which means
that only individuals who meet its strict criteria
will qualify. For 2019, in order to be
eligible for Medicaid, an individual cannot
own more than $15,450 in non-exempt
assets; however there are still income limits
and diff erent limits that apply whether one
needs nursing home care or home care, and
whether the individual is married or single.
Perhaps another option to consider would
be a reverse mortgage on one’s home. Th is
option would provide the individual with
money up front and the ability to possess his/
her home for the remainder of his/her life,
and any equity remaining upon death would
be an available asset for the individual’s heirs.
However, depending on the particular loan
and the amount borrowed against the home’s
equity, the loan balance, interest and fees may
continue to accrue and may use up the equity;
thereby lessening the assets passing to the
heirs, or leaving them with the home and the
loan to then repay.
An experienced Elder Law attorney can
explain these and other options, including
creating an appropriate estate plan and taking
advantage of gift ing, trusts and other
successful asset protection mechanisms and
strategies to properly protect one’s self, family
and fi nancial security. Engaging in proper
estate planning when an individual is healthy
and mentally competent is ideal, however
there are still alternatives available when one
is infi rmed. When there is no plan or coverage
in place and imminent care is needed,
there is still the ability to preserve half of
an individual’s assets on the cusp of requiring
nursing home care. Regardless of one’s
stage in life, it is prudent to be concerned
with the rising costs of aging and the possible
attendant costs of nursing home care in
New York. Th erefore, seeking the advice and
counsel of an experienced Elder Law attorney
who specializes in this area is critical.
Ronald A. Fatoullah, Esq. is the founder
of Ronald Fatoullah & Associates, a
law fi rm that concentrates in elder law,
estate planning, Medicaid planning, guardianships,
estate administration, trusts, wills,
and real estate. Adam D. Solomon, Esq.
is an attorney with the fi rm. Th e law fi rm
can be reached at 718-261-1700, 516-466-
4422, or toll free at 1-877-ELDER-LAW
or 1-877-ESTATES. Mr. Fatoullah is also
a partner advisor with Advice Period, a
wealth management fi rm that provides a
continuum of fi nancial and investment
advice for individuals and businesses, and
he can be reached at 424-256-7273.
RONALD FATOULLAH
ESQ, CELA*
/WWW.QNS.COM
