Last week we wrote about the different types of elder care facilities and the types of amenities they typically offer. This week we’re going to discuss some practical tips you can use once you begin investigating facilities you’ve identified. These tips are designed to help you determine whether an elder care facility is right for you and your individual needs and preferences.

Appointment First, Unannounced Later

Start the process by making an appointment to tour individual facilities. Once you have done this you can then select a few that you like and then, later, show up unannounced for additional visits. It’s typically best to do this around mealtime.

Private Discussions

The residents of an elder care facility will often be a good source of information, so you should try to talk to them as much as possible. You should always do this without a staff member present so you can be sure you are speaking in private. However, you should also take criticisms or even recommendations with a grain of salt, as each person’s expectations and experiences will differ.

Review the Rental Contract

Before you commit to anything you should always carefully review the resident contract agreement. These can often be rather long, so you should ask to be able to take it home and review it. You should also take it to your estate planning attorney and ask him or her to review it to make sure there is nothing potentially problematic.

John R. Vermillion & Associates, LLC is a member of the American Academy of Estate Planning Attorneys.

The aging process is often difficult for both elderly people and their children. Along with the medical complications and loss of capabilities, elderly people also face the difficult situation of losing their independence. Once an elderly person becomes unable to drive or operate a motor vehicle safely, bringing up the conversation about taking away the keys is a difficult, but necessary step.

Start with medical conditions.

If your parent has medical conditions or problems that impact his or her ability to drive, this is a good way to begin the discussion. Obvious medical conditions, such as visual or hearing impairments, as well as loss of muscle control, should prompt an immediate discussion about driving and what other options are available to the parents.

Follow-up with ride a longs.

If there are no obvious medical conditions impairing the parents, or the parent does not have to take medication that could cause a loss of driving ability, it’s best for adult children to ride as a passenger in the parent’s vehicle as the parents drives. This will allow you to determine if the parent’s age has resulted in a decline in driving ability. These declines are not always easy to determine, and it’s best to take regular drives with the parent and pay special attention to reaction times, coordination, and other important driving skills.

John R. Vermillion & Associates, LLC is a member of the American Academy of Estate Planning Attorneys.

The Medicaid expansion provisions provided for by the Patient Protection and Affordable Care Act, commonly known as Obamacare, have been staunchly opposed by numerous Republican lawmakers and state governors, though according to at least one expert, a majority of states will adopt the expanded eligibility criteria by the 2014 deadline.

According to Richard Zoretic, executive vice president of WellPoint Incorporated, most states will expand Medicaid to include anyone who earns up to 133% of the federal poverty limit, as outlined under the healthcare law.

A recent report published in the New England Journal of Medicine seems to support this claim for majority adoptions, as it has identified 22 states that are currently intending to expand Medicaid, while 12 state governors have indicated they will staunchly oppose such an expansion. At least three of those 22 states have Republican governors, and several other states have yet to make a determination.

The expanded Medicaid criteria are set to take effect on January 1, 2014. For states that expand Medicaid under the terms of the healthcare law they will have the costs associated with expansion covered by the federal government for the first several years. Unless states choose to adopt the expansion completely the federal government has also stated it will not cover any associated expansion costs.

The expansion is designed to address the current gap in Medicaid coverage and will bring healthcare coverage to an additional 16 million Americans. Currently, individual states determine who is eligible for Medicaid and coverage criteria differ significantly.

John R. Vermillion & Associates, LLC is a member of the American Academy of Estate Planning Attorneys.

For adult children with aging parents there is no single way to determine if your parents need more help than they are currently getting. There is also no single solution that will fit in all situations when you finally determine that your parents need a little more help. If you have aging parents and are concerned about their ability to care for themselves, here are some tips that might help.

Communicate, Communicate, Communicate

Helping aging parents is not always easy, especially when they are reluctant to acknowledge their own limitations as a result of their age. It is vital to keep open communications with your parents if you are concerned about their abilities to care for themselves, but not in an accusative or confrontational manner. Simply asking if there’s anything you can do to help or commenting on some simple tasks that may have gone uncompleted can do a lot to help foster an environment of positive support.

Get Professional

Even though your parents may regularly see their doctor, aging often requires the trained eye of an experienced expert. If your parents haven’t already done so you can ask them to schedule an appointment with a geriatric care specialist to schedule a geriatric assessment. These tests typically take about two hours, during which time the specialist measures not only physical abilities, but also cognitive capacity and other health aspects. Once you schedule an assessment you can go with your parents and ask the doctor about any specific concerns you might have.

John R. Vermillion & Associates, LLC is a member of the American Academy of Estate Planning Attorneys.

A new study from the U.S. Census Bureau’s America Community Survey shows that the trend of multigenerational families living under the same roof continues to gain steam. The survey, released late last year, shows that about 5.6% of all American family households are multigenerational.

The estimated 4.3 million multigenerational households in the country represent a significant increase over the past 10 years. In 2000, only about 3.7% of households included multiple generations, while by 2010 that percentage increased to 4%. The 1.6% increase in the number of multigenerational families is a drastic increase from the .3% increase seen during the previous decade.

Researchers say there are a number of factors that contribute to this rise in multigenerational living. One factor is that immigrant families tend to have a much higher percentage of multigenerational households, and those households tend to be clustered more strongly in areas where property values are high or there is a limited supply of available housing.

However, another significant factor is the aging of the American population. It’s estimated that about 10,000 baby boomers reach retirement age every day. As these people retire they sometimes choose to live with their children for any number of reasons. Some of them choose to minimize elder care costs, others prefer living in the same household with the grandchildren, while other families find the saved expenses of combining generations to be a significant financial benefit.

The study also revealed that almost 2/3 of multigenerational households had parents and children living with a grandparent.

John R. Vermillion & Associates, LLC is a member of the American Academy of Estate Planning Attorneys.

The Bureau of Labor Statistics regularly collects a range of survey data about American jobs, the workplace, and how the average American spends his or her day. In 2011, the BLS began collecting information about how many Americans spend their time providing unpaid eldercare services. The data, collected as part of the American Time Use Survey, has revealed that eldercare is becoming increasingly common as the American population continues to get older.

In 2011, 39.8 million people provided eldercare services in a non-institutional setting. About 56% of those people were women, and those between the ages of 45 to 64 were most likely to provide services.

Almost 70% of those providing eldercare assistance did so to a single person, and 42% did so for a parent. On days when people provided eldercare, they spent an average of just over three hours doing so. Also, about 23% of those providing services were parents who had at least one child under the age of 18 living at home.

As defined by the BLS, elder care includes a broad range of activities, ranging from providing transportation assistance, to purchasing goods or services, recreational services, or spending time with an elderly person. An elderly person is defined as someone age 65 or older who needs assistance with any condition related to aging.

John R. Vermillion & Associates, LLC is a member of the American Academy of Estate Planning Attorneys.

Visiting your aging parents over the holidays does not have to be strictly confined to the giving of gifts and telling tales of yesteryear. If it has been awhile since you’ve seen your elderly parents, use your visit as an opportunity to assess their physical and mental acuity, as well as the status of their estate plan(s). The following lists may help determine what steps you can take to allow your parents to age with dignity, within the confines of their own home, for as long as possible.

Legal documents

Do they have advance directives in place such as a living will or healthcare power of attorney? The former allows them to dictate what types of medical procedures they are willing to undergo, should they be unable to say it for themselves; the latter grants power to a trusted person to make medical decisions on your parents’ behalf. If these documents are missing, see if you can help them create them. Additionally, you should make sure that they have a will in place.

Eldercare plans

If your parents are having difficulty carrying out their day-to-day tasks, what sort of eldercare plans do they have in place, if any? If their needs are small, such as requiring help with preparing meals, perhaps a home-healthcare aide would be advantageous; if their needs are greater, what types of facilities are nearby that can provide assistance?

Finances

Should your parents’ mental acuity be lessening, perhaps you can speak with them about granting you financial power of attorney, so that you can better manage their finances.

John R. Vermillion & Associates, LLC is a member of the American Academy of Estate Planning Attorneys.

For the most part, our society respects the contributions the elderly have made and demand that they be treated accordingly. Not all people share that sense of respect, or become frustrated and overwhelmed when dealing with an elder suffering from mental or physical afflictions, and are abusive toward them. Since an elderly person is unlikely to report such abuse it’s important that society learns to recognize the warning signs of elder abuse.

Elder abuse occurs in many different forms, such as neglect, or the more commonplace physical, emotional, or sexual abuse. Additionally, because the elderly have had a lifetime to develop their finances, they are often the victim of financial abuse. Healthcare abuse is another form of abuse to which the elderly are susceptible because of their access to Medicare and Medicaid.

The warning signs of physical abuse include: unexplained signs of injury, like bruises, especially when the bruising occurs on two sides of the body; broken bones, sprains, or dislocations; broken eyeglasses; signs of physical restraints, such as rope marks; and, the caregiver refuses to allow you to see the elder alone.

Signs of neglect include: unusual weight loss or dehydration; untreated physical problems, like bed sores; unsanitary living conditions or personal hygiene; or inappropriate clothing for the weather conditions.

Financial abuse may involve large, unusual withdrawals from their accounts; a sudden financial change; missing items or currency from the elder’s home; suspicious changes in wills, power of attorney, deeds and titles, or insurance policies; and the addition of names to the senior’s signature card.

John R. Vermillion & Associates, LLC is a member of the American Academy of Estate Planning Attorneys.

The costs associated with a stay in a nursing home continue to rise higher than ever and show no signs of slowing down. With annual costs exceeding $73,000, living in a nursing home could make short work of one’s life savings if no steps are taken to minimize or offset the damage. But what can you do to help protect yourself?

You need to realize that the majority of health insurance plans do not cover the cost of a nursing home. Medicaid may be of use, but qualifying for its coverage can be tough if you don’t meet the financial criteria. Although these criteria may seem unfair, they were put in place to prevent people from giving away their money in the years immediately preceding their entrance into a nursing home, then expecting the government to pick up the tab.

Despite these restrictions there are ways to get your assets out of your estate, legally, prior to entering a nursing home. One way is to through the use of gifts. The IRS allows up to $13,000 to be given as a gift – tax-free – each year. By making large gifts to your children, you may be able to avoid losing the money to a nursing home; of course, it wouldn’t hurt if your kids placed that money into a trust that’s created for your benefit. Another method is for your children to pick up the costs, which, if they pay at least 50% of the medical costs, allows them to deduct a portion.

John R. Vermillion & Associates, LLC is a member of the American Academy of Estate Planning Attorneys.

This September 9th will mark the 33^rd anniversary of National Grandparents Day. The day was first celebrated in West Virginia in 1970 after Marian McQuaid of Oak Hill, West Virginia, persuaded the governor of that state to recognize it as an official day. By 1978, the day became a nationally observed one after President Jimmy Carter signed an official declaration stating it would fall on the first Sunday following Labor Day of each year.

Though it is currently recognized as an observance and not a national holiday, Grandparents Day did not always meet with widespread acceptance. After her success in getting West Virginia to recognize the day, Ms. McQuaid attempted to have Congress recognize it as well with the aid of US Senator Jennings Randolph of West Virginia. He introduced a resolution into Congress in 1973, but little action was taken.

Undeterred by Congress’s inaction, Ms. McQuaid gathered supporters of Grandparents Day and began petitioning other state governors. She asked them to have the day recognized in their states even though Congress had not acted to recognize it on a national level. Her actions were so successful that by the time President Carter signed the official proclamation recognizing the national day, 43 states had already recognized it on the state level.

For her actions, Ms. McQuaid was honored in 1989, on the 10^th anniversary of Grandparents Day, when the United States Postal Service released a commemorative envelope with her likeness upon it. She died in 2008 at the age of 91, leaving behind a combined 58 grandchildren and great-grandchildren.

John R. Vermillion & Associates, LLC is a member of the American Academy of Estate Planning Attorneys.