Jeanne Zieff is a social worker and elder abuse program coordinator for a nonprofit agency, the Community Agency for Senior Citizens, based on Staten Island. She and her coworkers are seeing their elderly clients struggle with relatives who have been demanding their FEMA checks or moving into their homes, and are facing everything from verbal mistreatment to physical neglect.

Various groups and agencies across the U.S. are working to support the elderly and raise awareness of elder abuse, but the like Zieff’s office on Staten Island, they have funding issues and face a crushing workload. Zieff’s office has faced recent cuts, and must lobby every year to stay open. The office is one of five which shares a yearly fund of $800,000 – – a minuscule amount for the territory they cover and the caseloads they juggle.

Most Senior Citizens agencies work in similar straits – a small staff, an underfunded program, and daunting cases which need expert training and a delicate touch. Elder care social workers must conduct intensive case work, accompany clients to court hearings and bank errands, fill the role of therapist in counseling sessions, make daily home visits, stay on top of all documentation, hold outreach sessions for everyone from bank tellers to first responders to educate them to identify signs of elder abuse, and update agencies such as Adult Protective Services.

As baby boomers age, the demographics mean that even more seniors will be facing elder abuse. Financial exploitation continues to be the most common type of elder abuse, with the adult children of the elderly helping themselves to funds or even pocketing their parent’s monthly Social Security check. Often, the first sign of elder abuse is when the senior seeks help for an impending eviction or other financial issue. The case manager may stumble across elder abuse without ever suspecting it.

Social workers and other elder care advocates know that elder abuse affects all ethnicities and social groups, and, as one of the most underreported crimes, continues to be a hidden public health crisis. Ninety percent of the perpetrators are the children of the elderly victims. A study from 2010 looked at the prevalence of elder abuse in New York State; for every reported case, as many as 24 others go unreported. Some 120,000 seniors in New York City over the age of 60 experience some form of elder abuse during any 12-month period. For older seniors, that rate is 14 percent.

John Hale is a Dallas elder law attorney and Dallas estate planning lawyer with The Hale Law Firm. To learn more visit http://www.thehalelawfirm.com.

Medicare pays the entire bill for the first 20 days of care in a skilled nursing facility, such as rehabilitation in a nursing home, but only if the patient was previously admitted to a hospital for at least three days. If the individual was instead placed under observation at a hospital, Medicare pays no part of the nursing home stay, which often costs well over $1,000 per week.

Further complicating the matter for patients is the fact that hospitals are not required to inform patients of their status until they are discharged and are permitted to designate patients as being in observation at any point during their stay – even retroactively.

Hospitals are increasingly placing Medicare beneficiaries in observation and keeping them there longer. The Medicare Benefit Policy Manual says that only in rare cases should hospitals keep patients under observation for more than 48 hours. But Brown University researchers, in a recently-published nationwide study of Medicare claims, found that in over 10 percent of cases, patients in observation were kept in that status for over 48 hours. The study also showed that from 2007 to 2009, the ratio of Medicare patients in observation at hospitals versus those admitted as inpatients increased by 34 percent.

The increase in this practice is likely an unintended consequence of recently-enacted Medicare rules that penalize hospitals for unnecessarily admitting patients and admitting individual patients more than once in a short time span.

Medicare auditors, in an effort to control costs, are increasingly investigating cases in which the agency believes that a hospital admission may have been unnecessary. Also, Medicare will soon start penalizing hospitals that readmit patients less than one month after discharging them – a policy intended to improve hospital care.

The Center for Medicare Advocacy has filed a class action lawsuit against the United States government calling for the abolition of observation status; the American Medical Association has requested that Medicare do away with the policy requiring a three-day hospital stay in order to be covered for nursing home rehabilitation.

The bottom line? If you are a Medicare patient, ask about your status each day you are in the hospital. If you are in observation status, ask your own doctor whether that status is justified. .

John Hale is a Dallas elder law attorney and Dallas estate planning lawyer with The Hale Law Firm. To learn more visit http://www.thehalelawfirm.com.

SitterCity, a Chicago-based online company that matches families and caregivers, is now providing senior care matching services, as well. The expansion, known as Years Ahead, was put into place prior to the holiday season, as the holidays are the busiest time of year for senior care needs. The general manager of Years Ahead, Melissa Marchwick, says that adult children most often notice the aging of their parents when they are able to spend longer periods of time with them, such as during holiday visits.

SitterCity was first launched more than ten years ago to help families find babysitters for young children. They then expanded to offer databases for housekeepers, pet sitters, and tutors – and now, senior companions. The need for senior care and tasks involved were found to be extensive enough that the company soon launched a separate platform and website, the better to explain senior living options, from assisted living to home health care.

One of the most helpful things about the site design is the “Care Path Needs Assessment,” to be completed online. Users answer questions about current medical conditions and cognitive abilities of the senior, and are assigned an independence rating on a scale from 1 to 5. The rating helps to match the right level of care and additional resources. Users are also able to work with a care adviser who can help explore facility options and give more input on choosing the right care provider. The system is free for search users; professional caregivers and other providers pay a membership fee to be listed on the site. According to Years Ahead, there are more than 34,000 facility and in-home senior care providers currently in the network.

There are other senior care provider sites cropping up across the web, from private companies to government-sponsored sites. As of 2011, more than 8,000 people turn 85 every day. By the year 2025, it is estimated that 20 percent of the U.S. population will be seniors — more than 72 million people. And while many of those seniors will be in good health, a large number of them will still need some degree of support and care.

John Hale is a Dallas elder law attorney and Dallas estate planning lawyer with The Hale Law Firm. To learn more visit http://www.thehalelawfirm.com.

MetLife has some suggestions for caregivers when it comes to their own financial security. First, caregivers should keep in mind their own financial future. If they cut back on hours or leave work to care for someone, they will not only lose some (or all) of their paycheck and curtail their possible career options in the future, they will also be losing future benefits such as a pension plan, the funds that would be part of a company’s matching to their 401(k), and their higher, eventual Social Security benefits. Instead of quitting, think about trying to work flex-time or explore taking a Family and Medical Leave (FMLA). Caregivers should check with their employer’s Human Resources department before making any drastic plans.

Also, if a caregiver becomes injured or disabled, they may not be able to provide financial support or life skills care to anyone else. As a preventative measure, they may want to consider disability income and long term care insurance, which will help with some level of financial support. They also need to maintain their own health care coverage; research shows that caregivers typically have more health complaints due to stress and extension than non-caregivers. Be sure to periodically review health insurance coverage to make sure it covers what is needed.

Caregivers often do not realize the extra expenses they can outlay when caring for someone else. Make a detailed list of items purchased and services paid for, being sure to save receipts, and run a budget to see what is sustainable, and where changes will need to be made. Everything from making extra meals to travel expenses can add up.

Caregivers should also look into what public benefits are available. The U.S. Administration on Aging, at www.eldercare.gov, has an Eldercare Locator which can assist caregivers in finding help in their community. There is also a free site, www.BenefitsCheckup.org, which lists programs that may cover some prescription drug, personal items, and other health care costs.

John Hale is a Dallas elder law attorney and Dallas estate planning lawyer with The Hale Law Firm. To learn more visit http://www.thehalelawfirm.com.

The most important thing the survey determined is that location matters. The average rate charged nationwide for a nursing home private room is $248 per day, which adds up to $90,520 per year. The cost varies widely from state to state, though, with the same room costing more than $400 per day in Connecticut, but only $157 per day in Louisiana. If you are an older resident of California, your nursing home costs will very well be exorbitant in the San Francisco Bay Area, but is closer to the national average if you are further south, such as Los Angeles or San Diego.

And when additional care comes into the play, the cost skyrockets. The average cost nationwide for 20 hours each week of home-health aide care in your own home will cost you more than $21,000 for the year. Living in an assisted living facility will cost you just over $42,000. If you want or need a private nursing home room, that will cost you an average of $90,520 each year.

And, if you or your loved one has dementia or Alzheimer’s disease, that will likely increase your cost. The MetLife survey looks at costs for Alzheimer’s and dementia care nationally and found that a mere 20 percent of nursing homes surveyed will charge extra for dementia care, while 61 percent of assisted-living facilities will charge extra. The additional care at a nursing home will increases costs by some 5 percent. The extra care at an assisted living facility will increase the cost by as much as 35 percent.

How long will you need elder care, and will you need it at all? According to experts, fewer than 50 percent of U.S. citizens who are now 65 will need nursing home care for any length of time, while less than10 percent will need nursing home care for more than five years. The issue is that you never know ahead of time if you will need that care. It is best to plan for any eventuality, to ensure that you are safe and cared for in your later years.

John Hale is a Dallas elder law attorney and Dallas estate planning lawyer with The Hale Law Firm. To learn more visit http://www.thehalelawfirm.com.

The ClockReader test is performed with a stylus and computer or tablet, such as an iPad. The participant draws a clock with numbers and hands in the correct spots, as instructed; the software checks for 13 traits, including correct number placement and correct hand placement. Participants who have some level of cognitive impairment typically draw on a clock face with either too many or too few numbers, with digits misplaces, and/or incorrect time indicated.

The accompanying software system ClockAnalyzer scores the test, notes the duration of the test, and even notes the time taken between each stroke. The software replays the participant’s test in real time, allowing the clinician to observe the drawing as it is created. The researchers at Georgia tech have yet to make the ClockReader available for the public; the research for the project was supported by the National Science Foundation.

In the UK, an early warning test for Alzheimer’s has been developed that can be taken online in just 15 minutes. The Cognitive Function Test spots early signs of the degenerative brain disease via an interactive quiz, then provides instant results and lifestyle advice to participants. While some types of dementia are not reversible, it is currently believed the brain shrinkage which is linked to Alzheimer’s can be delayed by up to five years with a vitamin regimen. The at-home test follows a study published by Oxford University which reports that a vitamin regimen of several vitamin B supplements may halt brain shrinkage by up to 500 per cent.

“More than 5 million Americans have Alzheimer’s disease,” says Waxahachie elder law attorney John Hale. “And one of the tragedies around the disease is that we still know so little about how to halt it.”

The test can measure mild cognitive impairment which may indicate incipient Alzheimer’s disease. Researchers are still working on identifying all the triggers, genetic and biological, that cause Alzheimer’s disease.

John Hale is a Dallas elder law attorney and Dallas estate planning lawyer with The Hale Law Firm. To learn more visit http://www.thehalelawfirm.com.

The researchers examined more than 30 studies that sourced autopsies to detect undiagnosed medical issues leading to death in adult ICU patients More than one-in-four patients – some 28 percent – were found to have one or more missed diagnoses at death. Additionally, 8 percent of the patients had a diagnostic error found to be serious enough to either have caused or directly contributed to his or her death. . They determined that the misdiagnoses made by medical staff also included care meant to help an incorrectly identified condition. The lead author of the paper, Bradford Winters, MD, is Associate Professor of Anesthesiology and Critical Care Medicine at Johns Hopkins. He stated that he hoped the article would be a wake up call to medical professionals and patients alike.

The researchers stated that autopsies helped identify, in retrospect, the mistakes made and cause of death, and their study highlights a need to develop better treatment to reduce diagnostic errors. Common medical errors included missing that a patient had pneumonia or a heart attack, like the case of a patient presenting with symptoms that were treated as a blood clot in the lung, but was later found, upon autopsy, to have been a heart attack. In another case, the medical team missing a diagnosis of a serious fungal infection, one serious enough to take down a damaged immune system. Medical conditions most commonly missed, besides heart attack, was pneumonia and pulmonary embolism.

According to Dr. Winter, lowering the rate of inaccurate diagnoses may require equipment upgrades and improvements to medical technology, including improved imaging and blood tests. However, what hospitals can do now, says Dr. Winters, is to reduce the amount of distractions, follow care checklists, which may include if/then care steps, and ensure that the standard ICU nurse-to-patient ratio to 1-to1.

The 5,863 autopsies listed ion the 31 reports included those not just in the U.S., but internationally, including Brazil, France, Germany, and Slovenia. The studies of the autopsies that were performed on U.S. patients, researchers estimated that between 22,600 and 40,500 of the dead may have died due to a missed diagnosis – as many deaths each year as occur in the U.S. due to breast cancer.

John Hale is a Dallas elder law attorney and Dallas estate planning lawyer with The Hale Law Firm. To learn more visit http://www.thehalelawfirm.com.

There are several elements to an estate plan, including a will, assigning who will be given the power of attorney, if needed, and a health care plan, which may include a living will or designating someone to have medical power of attorney on your behalf. You may also wish to consider setting up one or more trusts.

Will. Your will designated what happens to your assets – your insurance policy, retirement savings, real estate holding and any investments, when you are no longer alive. Your will dictated who will inherit your assets, and will designate the guardians for any minor-age children you may have.

Financial Power of Attorney. If you become mentally incapacitated due to an accident or illness, your financial decisions will need to be overseen by someone who can make decisions on your behalf.

Medical Power of Attorney. If you become mentally incapacitated due to an accident or illness, your medical decisions and care plan will need to be overseen by someone who can make decisions on your behalf.

Trust. While may think of a trust as something only put into place by the very wealthy, in truth, a trust is a legal mechanism that allows you to place conditions on how and when specific assets can be distributed when you die. A trust also will allow you to lower the amount of estate and gift takes you pay, and is a way to distribute your assets to any heirs you may have. A trust may also be put into place to offer protection of some of your assets from lawsuits and creditors.

Take some time to inventory your assets, including business interests, real estate holdings, insurance policies, and retirement fund. Consider how you would like your assets distributed. Work with an experienced estate planning attorney to designate both financial and medical Powers of Attorney, and map out what health care proxy or living will specifics are important to you.

John Hale is a Dallas elder law attorney and Dallas estate planning lawyer with The Hale Law Firm. To learn more visit http://www.thehalelawfirm.com.

Though the reality that you or your partner may eventually need some sort of long-term care is not something many people want to consider, smart estate planning includes looking at all contingencies. And the best time to map out your long-term care plan is long before it is even needed. Do not wait until a crisis arises to develop a plan for when you need care beyond what you can provide for yourself; take time to decide how you will finance any care you need and how decisions regarding that care will be made.

Long-term care can encompass a broad range of services and support to help you meet your health or other personal needs over an extended period of time.

When designing your long-term plans, there are a number of factors to consider:

• If you become ill or are otherwise incapacitated, would you want to stay in your home or at an assisted living residence?
  • If at home, who would care for you? Do you have confirmation from that individual or funds for in-home care?
• Do you have the resources to pay those costs directly from your finances, should the need arise?
• If not, would you be able and willing to sell your home to pay for your care?
• If you need additional funds, do you have family who will help pay for your long-term care expenses?
• If you will need Medicaid, do you meet the eligibility requirements?
• If you need to relinquish control of your estate, to whom would you transfer financial power of attorney

These are simply jumping-off points for more in-depth discussions to have with your loved ones, your family and with someone well-versed in elder care and estate law. You may need to explore these questions in a series of conversations over a length of time, rather than in one session. What is important is to provide the foundation for your long-term care plans.

John Hale is a Dallas elder law attorney and Dallas estate planning lawyer with The Hale Law Firm. To learn more visit http://www.thehalelawfirm.com

The federal estate and gift tax system currently in place includes a number of options for gifting and transferring wealth without extreme taxation. A “lifetime gift” is an amount someone can give to someone else yearly, free of transfer tax. The lifetime gift amount is currently $13,000 per gifted individual. If a lifetime gift exceeds the exclusion amount, it is considered a taxable gift, and taxable gifts are tallied during a person’s lifetime.
Also, as it currently stands, when someone passes away, his or her assets are tallied, and deductions are taken for expenses and items passed to a spouse or donated to a charity. There is also an amount of wealth, called an estate tax exclusion, that can be transferred, tax free, from the decedent’s estate. (Though some have nicknamed it a “death tax,” the amount that is taxed is called a “transfer tax.”)

If the decedent’s estate transfers an amount of wealth below the exclusion amount, after donations, etc, no tax is due on that transferred amount. For 2012, a decedent estate’s federal estate tax exclusion is $5.12 million, with the taxable value of estates and gifts tax rate of 35 percent. However, there is also a federal gift tax exclusion for 2012, also set at $5.12 million, which means that a large amount can be transferred with no gift tax.
For individuals and married couples with large estates, it is advisable that they meet with a qualified estate planning attorney to decide how to manage the entirety of their $5.12 million exclusion prior to the end of this year, either with one of several trust options or through gifting or by staying the course already set out for them.

Regardless of how you may decide to transfer, gift or otherwise manage your assets, the current rates and exclusions are set to expire on January 1, 2013, with federal estate tax exclusions and gift tax exclusions falling to $1 million, with a top rate of 55 percent.

If you have not already done so, work with a well-established elder law and estate planning professional to establish a plan that works for your estate. Be sure to update your listed beneficiary(ies) on retirement accounts, annuities, life insurance polices and any other accounts, to be certain they are included in your estate plans.

John Hale is a Dallas elder law attorney and Dallas estate planning lawyer with The Hale Law Firm. To learn more visit http://www.thehalelawfirm.com.

Savings have been hit hard because of the sagging economy, investment losses, and depressed home values. Complicating matters is sky-rocketing health care costs associated with Mom or Dad’s long-term care. An experienced elder law firm can help preserve assets, connect with government benefits and resources, and create a contingency plan to address possible changes.

As you explore options on how to best take care of your parents, it is important that you understand the legal implications of your good intentions. A false step could result in lost Medicaid eligibility, adverse tax consequences, or any number of other legal or financial problems. Discussing your situation with an elder law attorney should be the first step you take in helping your parents safely navigate the complex legal and financial issues associated with caring for them.

Families oftentimes rely on bad advice from family members, their financial advisor, accountant, or even their attorney, when developing a financial plan to care for an aging parent. Take for example the case where an elderly parent builds an apartment on a child’s property so that he or she can be closer to family. The money spent by the parent to build the apartment could be interpreted as a gift that could result in lost Medicaid eligibility and gift taxes.

People are beginning to understand the importance of involving an experienced elder law attorney early in the retirement and long-term care planning process. Nothing should be taken for granted. You should not make the mistake of relying on common sense to the exclusion of good legal advice.

John Hale is a Dallas elder law attorney and Dallas estate planning lawyer with The Hale Law Firm. To learn more visit http://www.thehalelawfirm.com.

HHS heeded warnings by the actuary for Medicare and Medicaid that the program was likely to be insolvent, which would cause premiums to rise for individuals who sign up for the program. As the costs increased, the projected $50 a day benefit would not have been enough to attract healthy, young people to pay for the long-term care program. After much debate, CLASS could not be proven to “…be self-sustaining, financially sound for 75 years, or affordable to consumers.”

Though CLASS has been cut, the rest of the 2010 health care act remains in place, albeit under much scrutiny and debate given political and economic climate. The major provisions of the health law are slated to go into effect in 2014, including insurance exchanges and Medicaid expansion, barring any modifications between now and then.

“By 2020, we know that an estimated 15 million Americans will need some kind of long-term care,” said HHS Secretary Kathleen Sebelius. “If we want our family members, friends, and neighbors to be able to live with the maximum amount of freedom and independence, we need to make sure they have access to the long-term supports that make that possible.”

At this time, the best long-term support is a skilled elder law attorney to assist with long-term care planning and asset protection. The federal government has proven itself unable and unwilling to address long-term care in a meaningful way. With average nursing home costs approaching $4,500 per month, a life savings can be quickly depleted. Further, the majority of Americans are unaware that Medicare covers only short-term rehabilitation.

A free initial case evaluation and consultation with an estate planning and elder law attorney can uncover how one’s assets and income can be legally repositioned to obtain long-term care Medicaid benefits and keep a life’s legacy intact.

Jacob Hale is a Dallas elder law attorney and Dallas estate planning lawyer with The Hale Law Firm, P.C. in Dallas and Waxahachie, Texas. To learn more, visit http://www.thehalelawfirm.com.