It is the perennial story: a parent, a widow or widower, can no longer live at home because of a form of dementia. They need what has come to be called a “memory care” facility. That used to mean going to a nursing home, but there are alternatives now. For more seniors the option is “assisted living,” often called memory care. There is a wide range to choose from in the Detroit – Metro area with new ones opening frequently.
Families will tour the assisted living facility. They will be greeted by a fresh attractive environment that promises a private room in a nice apartment style setting. Music from decades ago wafts from speakers in the gathering area. Some residents are watching an old Black and White classic film. The elders living there look clean and content. Pictures from long ago decorate the halls and resident rooms have pictures of themselves and family in their rooms.
What could possibly go wrong in this memory care paradise?
A recent article published in both Kaiser Health News (KHN) and the New York Times pointed out the dangers found in assisted living facilities. Loss of memory is not the only problem residents have. Many also have what is called in the Alzheimer’s arena “difficult behaviors.” In other forms of dementia, such as Fronto-temporal, difficult behaviors are the preeminent problem.
According to KHN difficult behaviors are potentially fatal in the assisted living paradise. Here are three common, avoidable problems that elders experience in assisted living facilities:
The KHN article observed:
“Aggressive behavior, a hallmark of dementia, is a major problem in assisted living facilities. One national study, published in 2016, found that 8 percent of assisted living residents were physically aggressive or abusive toward residents or staff.”
According to the report the problems in assisted living facilities is exacerbated when they are not subject to government oversight.
“[] the rules for assisted living remain looser than for nursing homes. The federal government does not license or oversee assisted living facilities, and states set minimal rules.
The government does not publish quality measures as it does for nursing homes. Inspections usually are less frequent, and fines are generally far lower than what a nursing home might incur for a similar mistake.”
The article is called “Assisted Living’s Breakneck Growth Leaves Safety Of Dementia Patients Behind.” You can find it here.
You can also read it on the New York Times website
What can you do when looking for a facility? In Michigan if it is licensed as Adult Foster Care or a Home for the Aged, you can check the state records and the office of the Michigan Long Term Care Ombudsman. If it is not licensed, and most in Michigan are not, you are best advised to make your own investigation. Try to speak to families who have a member in residence. What problems have they had? Discuss the problem of difficult behaviors with the admission person and determine their policy. If they have one, is it in writing? Can you review it?
After you make placement in any assisted living facility be vigilant for any signs of injury including a change in mental state, e.g. being fearful or withdrawn. If you see a problem investigate. If you have to move your elder you will have a case for full refund of deposit and the requirement of 30 day notice. Hopefully you will not have the problem of suing the facility for negligent care that seriously harmed your family member.
I see many attorneys advocating Medicaid pre-planning and in many cases their advice will leave a client worse off than if he or she did nothing. Why? Because they focus on the nursing home, they do not plan for alternatives to the nursing home. Let’s use a story.
Doctor Says It’s Alzheimer’s Disease
Carol Smith is 75, her husband is John, age 78. After years of Carol’s suspicion his doctor finally confirmed it. John has Alzheimer’s Disease. She knows what that means. He will likely be in a nursing home some years from now. The thought still makes her shudder as she remembers how horrible it was to have her mother in a nursing home.
With the help of her oldest daughter Ruth she began researching what to do. They read articles on the internet and, by luck!, an attorney was holding a “long term care” seminar with the slogan “Don’t lose your assets to the nursing home!” Carol does not want to lose all the savings she and John worked so hard to accumulate. This program “rang her bell.”
They Go to the Lawyer’s Workshop
During the program the attorney laid out the cold hard facts: if you go to a nursing home you can expect to lose everything, even your house will go to the government! But he offered good news: he had a Medicaid Protection Trust. They could save everything if they act now because Medicaid has this “5 Year Rule.” As the program ended Carol and Ruth signed up for an appointment.
At the Lawyer’s Office
The lawyer reviewed her financial information. “You have $50,000 in your IRA and John has $150,000 in his. You have $300,000 in other investments, your home is worth $250,000. And you have about $50,000 in other assets including your checking and savings accounts, car and life insurance. You are worth $800,000 and you risk losing all of it.”
The lawyer continued. “When is the best time to start protecting your assets? Now. You need to have your protection plan in place at least five years before he goes into a nursing home. Now here’s what we need to do.”
The Medicaid Pre-plan
The lawyer recommended a full Medicaid Pre-plan. They needed to replace their “estate planning documents” with “Medicaid planning documents.” Carol would cash out her IRA and put the rest of their assets in the irrevocable Medicaid Protection Trust. John’s IRA would be placed into an immediate annuity that would pay out over 60 months. They would live off their social security, his IRA payout, and income from the investments in the Medicaid Protection Trust. That would give them an income of about $4,700 a month. After five years John could go into a nursing home and he would be Medicaid eligible from day one. All their assets would be saved.
Carol’s head was spinning. She heard Ruth ask how much would it cost. The lawyer said with a $10,000 investment in your Medicaid plan you will save you $800,000. $10,000 Ruth asked? That’s right the lawyer said.
Carol was reaching for her checkbook when Ruth said to the attorney “We’d like to think about this.” The attorney completely understood but cautioned them that “delay could prove extremely costly. The earlier you act, the more you can be assured of saving.” He left the room to give them time to talk. Carol and Ruth talked. Ruth was skeptical but Carol was adamant. She did not want to lose everything they had worked so hard to gain.
Carol hired the lawyer. They did the Medicaid preplanning. They put their savings in the irrevocable trust.
The lawyer congratulated her. “You have protected your home and your life savings from the nursing home and the government.” But, he sternly warned, she could not get anything out of the trust otherwise the whole effort could fail.
Five Years Later
John’s Alzheimer’s is much worse. For the past two years he has been in a dementia care assisted living facility. Ruth helped Carol find it. He is doing well there. He has his own room and seems to like it. The cost is $7,000 a month.
Carol had to place him there. He was 24 hour care. One night she woke up and smelled something burning. There was smoke everywhere. John was watching TV. In the kitchen Carol found the burner on and something burnt in the pan. Another night, at 2:00 a.m. she heard the front door slam. The police later found him wandering around, trying to “go home.” Carol hired an in-home care agency for help during the day, it was expensive but still she was not getting rest! Finally her doctor told her either she places him or she will have a heart attack!
Now, in less than one year John’s IRA will be gone. They will be out of money. She cannot get at her savings and investments, those are in the irrevocable Medicaid Protection Trust. She can’t get a home equity loan, their home is in the Medicaid Protection Trust.
The Medicaid preplan will force Carol to put John in a nursing home. She fears what will happen. He is an active dementia patient. They will put him in a wheelchair with an alarm so that he cannot get out of it. If he becomes agitated they will drug him until he is compliant.
What’s wrong with this picture? They planned for the nursing home.
Unless a person’s monthly income is less than $2,199 (2017) Medicaid will only pay for care in a nursing home. Pre-planning for Medicaid is planning to go in the nursing home as soon as possible.
Moral
Don’t plan for the nursing home. Plan for the alternatives to the nursing home. Don’t put your savings into an irrevocable asset protection trust unless you have enough to pay for alternatives to the nursing home. If after budgeting for the alternatives you have excess savings, then use an irrevocable asset protection trust. This is a “life-care plan.” I’ll post on that later.
Got questions? Give me a call at (248) 356-3500.
All the best,
Jim
Continuing our posts during Alzheimer’s Awareness Month I would like to share an interesting blog post I came across. The authors are Judy M. Zarit, Ph.D., is a retired clinical psychologist and her husband Steven H. Zarit, Ph.D., is a retired Professor of Human Development and Family Studies at the Pennsylvania State University. They review some studies headlined in the news as breakthroughs. Now these studies are in fact genuine medical research studies. They are not phony “studies” by somebody peddling expensive, worthless pills to a vulnerable public. The authors Zarit bring their immense store of knowledge and experience to show that these studies are not breakthroughs, but just bricks in the long road to an Alzheimer’s cure. Read it here: http://giftofaging.blogspot.com/2015/10/newsflash-alzheimers-disease-has-been.html