Research shows that seniors recovering from knee or hip surgery have fewer complications recuperating at home instead of in a rehab facility, but what about those don’t have this option? Many seniors and their families are being pressured by hospital staff to select a rehab facility without enough time or information to choose wisely, potentially putting themselves at risk of receiving substandard care.

Choosing a Rehab Facility Can Be Daunting
In a recent Kaiser article written by Judith Graham, she writes, “Every year nearly 2 million people on Medicare — most of them older adults — go to a skilled nursing facility to recover after a hospitalization. But choosing the facility can be daunting, according to an emerging body of research.” As Graham explains, a nurse or a social worker will typically hand the patient and their family a long list of nearby facilities. Typically, the patient receives this list only a day or even hours before discharge. “Families scramble to make calls and, if they can find the time, visit a few places,” says the article, but they’re not given enough time or information to make an informed choice.

Often the family is not sure what the plan of care will be or what to expect.  Such as, what will recovery entail, how long will that take, whether nurses and doctors will be readily available, all the therapy options, or how much it will cost? Many of these questions are completely overlooked, but one of the biggest omissions from the list, is any indicator of quality. The list rarely includes essential information about the services offered or what type of care quality you can expect. In other words, patients must make critical decisions under extreme pressures, armed with insufficient and unreliable information.

Choosing a Rehab Facility can be Stressful and Confusing
This leaves patients and families without quality guidance at a vulnerable point in their care trajectory. During a highly stressful and confusing time, uninformed patients and families often make poor choices. In 2018 the Medicare Payment Advisory Commission (MedPAC) reviewed this issue and found that almost seven out of eight Medicare beneficiaries sent from a hospital to a skilled nursing facility for rehab chose a lower-rated care facility when higher-rated providers were available within 15 miles.  It’s not that families didn’t have choices, on average patients receive a list of 34 short-term rehab facilities, it’s just that patients lack the time and data to make informed choices. As the MedPAC report suggests, recovering seniors who are discharged to poorly-run rehab facilities are at risk of complications such as infections or medication errors, and because they may not be receiving the proper rehabilitation or therapy they need, it adversely affects their recovery. Because of this, many times the patient is unable to return home and could potentially end up as a permanent nursing home.

Choosing a Rehab Facility: Pre-Planning is Essential
There’s a lot to this issue, and we recommend families read the Kaiser Health News article for some of the details and some helpful links to related resources.

It’s important to get information early. Families should insist on seeing a discharge planner soon after entering the hospital and start the planning process long before the discharge date. Be insistent and keep asking what options are best for the patient.

Planning for your future as you age involves preparing for decisions like this, and that means honest communication with your loved ones and careful preparation to ensure you receive the type of medical care you need. These two elements – family and medical – combined with a solid financial plan, a carefully-crafted legal strategy, and a well thought out approach to your housing needs as you age are all part of planning for your future.

At Tacoma Elder Care we're here to help. We recommend you join us for one of our FREE Workshops to learn more or call to schedule a Free consultation today.

Donor-advised funds are gaining momentum due to the new tax law. These funds allow you to donate money and receive a charitable tax deduction.

A donor-advised fund is established through a charity or nonprofit, and allows you donate assets (it can be cash, stocks, or real estate) to the fund. The gift is irrevocable – the nonprofit controls the assets and you cannot get the assets back. You may then take an immediate tax deduction for the gift to the fund. Once the fund is established, you can tell the fund where to donate the money, and when.

These funds are becoming more popular in part because the new tax law enacted in 2017 doubled the standard deduction to $12,000 for individuals and $24,000 for couples. This means that if your charitable contributions along with any other itemized deductions are less than $12,000 a year, the standard deduction will lower your tax bill more than itemizing your deductions.

With a donor-advised fund you contribute several years' worth of charitable donations to the fund at once and receive the tax benefit immediately, making it more likely that itemizing would be more advantageous than taking the standard deduction.

There are different types of donor-advised funds. Some are available through financial investment firms and others may be smaller community funds such as universities and faith-based organizations. Each fund has its own rules on how the money is distributed. There may be limits on how much you can donate each year or a requirement that you donate a certain amount.

Before deciding to give to a donor-advised fund, you should investigate the fund's rules, fees, and how established the fund is. We suggest scheduling an appointment at Tacoma Elder Care for a consultation so we can help you review all your options.

Or learn more here. 

Caring for an ailing family member is difficult, but it doesn’t have to be unpaid work. There are programs available that allow Medicaid recipients to hire family members as caregivers.

All 50 states have programs that provide pay to family caregivers. The programs vary by state, but are generally available to Medicaid recipients, there are even some non-Medicaid-related programs.

Medicaid's program began as "cash and counseling," but is now often called "self-directed," "consumer-directed," or "participant-directed" care. The first step is to apply for Medicaid through a home-based Medicaid program. Medicaid is available only to low-income seniors, and each state has different eligibility requirements. The Medicaid application approval can take months, and there may be a waiting list to receive benefits under the program.

The state Medicaid agency usually conducts an assessment to determine the recipient's care needs—to determine how much help the Medicaid recipient will need with daily activities such as bathing, dressing, eating, and moving. Once the assessment is complete, the state draws up a budget, and the recipient can use the allotted funds to pay for goods or services related to care, including paying a caregiver.

Recipients can choose to pay a family member as a caregiver, but there may be some restrictions on which family members are allowed. Most programs allow ex-spouses, in-laws, children, and grandchildren to serve as paid caregivers, but typically family caregivers are paid less than the market rate in order to prevent fraud.

In addition to Medicaid programs, some states have non-Medicaid programs that also allow for self-directed care. These programs may have different eligibility requirements than Medicaid and are different in each state. Family caregivers can also be paid using a "caregiver contract," increasingly used as part of Medicaid planning.

In some states, veterans who need long-term care also have the option to pay family caregivers. In 37 states, veterans who receive the standard medical benefits package from the Veterans Administration and require nursing home-level care may apply for Veteran-Directed Care. The program provides veterans with a flexible budget for at-home services that can be managed by the veteran or the family caregiver. In addition, if a veteran or surviving spouse of a veteran qualifies for Aid & Attendance benefits, they can receive a supplement to their pension to help pay for a caregiver, who can be a family member.

To find out more about these programs, and to see if you qualify, contact Tacoma Elder Care for a consultation. Or attend one of our FREE workshops.

If your spouse passes before you, and your current Will leaves everything to him/her, or your children if your spouse passes before you, do you need to change your Will? And what if you don’t, will your house or property go automatically to your children?

You do not need to redo your Will if your spouse passes before you, provided your current Will provides everything you wish. However, if it has been several years since your Will was written, it should be looked at along with your other estate planning documents such as Power of Attorney’s and Health Care Directives to make sure these still work for you. These documents are only as good as the wording in them, and the wording should be updated to comply with any new laws or circumstances in your life.

As for your house passing to your children when you expire, note that this does not happen automatically. If the house is in your name, your “estate” will need to be “probated” (a legal process to administer a deceased person’s assets) so that a clear title to the house can pass to your children, or someone who purchases from the estate. This can take some time.

To be sure you have everything set-up correctly, you’ll want to make sure you have a “Community Property Agreement” transferring your spouse’s interest in the house/property to you automatically with no need to probate to clear their interest. Bank and financial accounts can pass outside of probate if the accounts are set-up correctly with beneficiary designations.

In general, it’s best to have a professional assist you to make sure you are covered regardless of how things play out, and that your assets pass on the way you wish when you die.

Join us for one of our FREE workshops, or call to schedule a FREE consultation today, and learn more about how to assure your loved ones are taken care of in the way you want them to be.

What would you do if a loved one was diagnosed with dementia and had to move to a memory care facility? The cost could easily exceed $9,000 per month which could quickly exhaust your savings leaving you penny less.

Paying for long-term care is frightening. Finding understandable answers is difficult. Fortunately, there remain resources to help pay for care without going broke. Medicaid is a Federal/State entitlement program that helps pay for long-term care. To qualify, one must be medically needy and meet resource and income rules.

An individual applying may only have “countable assets” up to $2,000. A couple’s assets may not exceed $55,547 or half the value of the assets up to $123,600 if the ill spouse has been in care for 30 days.

A legal strategy before applying is to transfer all the assets to the "well" spouse. The well spouse will then “spend down” to the allowable amount by either purchasing non-countable assets (prepaid burial or home improvements for example) or buy a “Medicaid Approved Annuity.”
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The rules are complex. To learn more register for a FREE Elder Law Workshop, or call to schedule a FREE consultation.

Great question! You grant your daughter the power to act by creating well drafted Durable Power of Attorney form.

A “Power of Attorney” is a document where a person authorizes another to act legally for them as if that person were them. Of the five estate planning documents all of us must have while alive, regardless of the amount of wealth we have, (Will, Durable General Power of Attorney for Financial Matters, Health Care Power of Attorney for Health Related Matters with HIPPA form, Health Care Directive and Community Property Agreement if married), the two Power of Attorneys are the most important.

It is imperative that we have someone empowered to carry on our affairs should we suddenly not be able to due to an accident, stroke, incapacity, or we’re simply too old to do so. Without it, expensive, invasive court proceedings such as Guardianships become necessary.

Not all Durable Power of Attorney forms are created equally so be sure to use an experienced attorney to ensure all necessary language gets included. Care must be given as to who can act and when.

To learn more, attend a FREE Elder Law/Estate Planning Workshop, or call to schedule a FREE consultation.