Family systems have a natural habit of stepping in to provide health care to their aging relatives. The love and care many adult children receive growing up become reciprocal, particularly in the case of their aging parents. But with the advent of longer lives, it is not atypical that a senior parent may still be caring for their parents or spouse. More than 16 percent of adult Americans are unpaid caregivers to someone age 50 or more according to Right at Home , a leader in the in-home senior care industry, and the number is projected to increase.

Many of these caregivers are trying to cope with their health challenges like osteoarthritis, diabetes, and more, while still providing care for others. The Family Caregiver Alliance reports that over one-third of caregivers are more than 65 years of age, with one-third of these older caregivers reporting their health to be fair or poor. The workload for many of these family caregivers precludes them from prioritizing a healthy lifestyle for themselves, often forgoing needed medical appointments or services, and some even lacking healthcare coverage at all. Some steps can be taken to break the cycle of a family caregiver putting their health at risk, which results in the same caregiving patterns and problems for the later generations.

Open a dialogue with your loved one’s healthcare provider as well as your own. If you do not have a doctor and annual physicals, it is time to get that in order. Inform both physicians that you are a caregiver and outline your routine and hours spent in the care for another. All health providers should know that caregiving is a known potential health risk that must be addressed. Take their advice to heart and implement strategies to protect your health.

Call a family meeting (which can be done via videoconference) with all siblings, adult children, and any other relevant family members. If family members live in different areas, they still need to be part of the discussion and the solution for the caregiving of their relatives. Caregiving roles often seem to happen by default. One family member starts with a few minor tasks, and it turns into something much more significant. You cannot and should not provide care alone. Especially a spousal caregiver can find it challenging to ask for help and, as such, suffer higher levels of depression, relationship strains, as well as physical and financial burdens. Caregiving works best when everyone participates in the best ways they can.

Check out support services both online and locally. Many adult caregiving guides can inform the family about the scope of their undertaking and provide a structure that can be divvied up among family members. Senior service agencies can recommend support and care services for your loved one as well as the primary caregiver. Devise a plan to meet the challenges head-on. Make amendments as health needs change and know there will likely come a time when your loved one would do better in an assisted living facility.

If an outside living facility is not possible, then get some downtime by bringing in a professional caregiver to lighten the workload on the primary caregiver. It can be just a few hours a week or a few days a week that someone else can reliably provide personal care, housekeeping, meal prep, transportation, and other services. Do some research to identify the right match of a professional caregiver to your family.

Knowing that you do not have to go it alone while providing care for a family member and risk your health in the process has a positive impact on both the care receiver as well as the caregiver. The time that is spent together is less stressful and guilt-ridden when caregiving is a shared responsibility.

We help families navigate the difficult decisions around caregiving and how to pay for care. We would be happy to meet with you to discuss your particular needs.

If you have questions or need guidance in your planning or planning for a loved one, please do not hesitate to contact our offices by calling us at (866) 456-9668.

The post What to Do When You and Your Loved One Need Caregiving appeared first on Faloni Law Group.

We are living in confusing and scary times. The senior population has been identified as the most at-risk demographic for COVID-19. Information coming out about COVID-19 is very fluid, which can also contribute to overall stress. Thankfully there are ways to try and manage stress and stay as healthy as possible during this time thanks to advice from several federal agencies monitoring the situation and the impact of COVID-19 on the senior population. This article highlights some of the advice provided from those agencies monitoring this situation closely.

For those living in a nursing home or long-term care living facility, new protocols have been established by the federal government to curb the spread of Coronavirus. A new preparedness checklist is available on the Centers for Disease Control and Prevention ( CDC ). It includes staff education and training for the rapid identification and management of ill residents, as well as an increase in supplies and resources. There are also restrictions on all visitation, excepting some circumstances like an end of life situation.  Other restrictions have been placed on volunteers and non-essential health care personnel, and the cancellation of all group activities and communal dining.

Before the identification and dissemination of information about Coronavirus, the CDC had identified the 2019-2020 flu season as being particularly challenging .
Now many seniors wonder whether they have a different type of flu, allergies, or are experiencing the Coronavirus. Not knowing is particularly frightening since seniors have been identified as the demographic with the highest mortality rate. The CDC has a straightforward checklist of symptoms of respiratory infection, including COVID-19:

Because other types of flu have similar symptoms and there is no Coronavirus vaccine, and its test is in very short supply, many older adults will only be able to treat their symptoms without full knowledge as to the contagion.

One their website under “ How to Prepare ” the CDC provides information on protecting yourself, your family, your home, and managing anxiety and stress. According to the CDC, there are some things that seniors can do whether or not they are in a facility or living at home that can help reduce their risk of catching the Coronavirus or any other virus for that matter in this bad flu season. The first line of defense sounds counterintuitive to a global pandemic, but it is crucial, stay calm and try to relax.

Getting quality sleep during this outbreak will allow your body the time it needs to restore immunity responses to contagions. Stay well hydrated by drinking plenty of water. Staying calm, getting restful sleep, and remaining hydrated will allow your body’s natural defense mechanisms to protect itself.

Have someone near you help you stock up on supplies. Stay in your home as much as possible. If the weather permits, open a window for fresh air. If you have a home with a porch or patio, take in some sun for vitamin D. You want your immune system to be as robust as possible. Take everyday precautions to keep space between yourself and others. If it is not necessary, don’t go out in public, avoid crowds, stay away from anyone who is sick, and wash your hands often. Cancel any cruise or non-essential air travel and do not use public transportation.

The Environmental Protection Agency ( EPA ) has posted a list of disinfectants for use against the Coronavirus. Proper disinfecting of often-used surfaces is critical as this particular Coronavirus can live for long periods, up to 72 hours on some surfaces. As of now, the EPA reports no detection of COVID-19 in drinking water supplies and believes the risk to the water supply is low based on current evidence.

The CDC is reporting that seniors with chronic medical conditions like heart disease, lung disease, and diabetes are at higher risk of contracting COVID-19 and should take extra precautions about self-isolating. Those seniors with these conditions in a nursing home or long-term care facility will be triaged according to CDC guidelines for best practices with the elderly who are the highest risk.

If you feel worried and panic is taking over your rational responses, seek a loved one or trusted friend to guide you through the steps you can take. There is a great deal that is unknown about the Coronavirus, but there is a great deal known about what you can do as an individual senior to combat the threat and remain healthy.

We would be happy to discuss any questions or concerns you have as we continue to understand the impact of COVID-19 on our country.

If you have questions or need guidance in your planning or planning for a loved one, please do not hesitate to contact us by calling our offices at (866) 456-9668.

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Many of us are facing unprecedented challenges during this coronavirus crisis in America, and it has increased anxiety and fear levels in all of us. The reactive part of your brain called the amygdala, a human physiological response when faced with fear, takes control of your actions, and you enter what is known as the fight-flight-freeze response. This stress response induces your body to produce a steroid called cortisol to handle the feelings of fear. Unfortunately, cortisol has another effect on your physiology; it weakens your immune system. This effect makes you more vulnerable at a time when you need strength.

No matter what your challenges are during this pandemic, there is one thing you can bring to the crisis from which all other problems can be better solved, overcome your fear with mental toughness. Being afraid can quite literally make you more susceptible to becoming sick. As such, the proper precautions like getting adequate rest, staying hydrated, and social distancing should have an additional component, help your brain to feel safe to maximize your physical health.

Some of the techniques you can employ include shifting your focus to those things you are grateful for, like a roof over your head, food in your refrigerator, your health. Consider all of the things you have that others may not; the things we all may typically take for granted. If you can’t find gratitude about your circumstances, think of those people working on the front lines in this continuing pandemic and be grateful it is not you. Finding something to be grateful for will immediately get you out of the fight-flight response.

Begin to practice empathy. Look at the time you spend with your loved ones at home as a gift and not a jail sentence. Embrace being with them, laugh, tell them you appreciate them because when you spread joy to others, it will boost their immune system as well. It turns out that being positive is healthy and
contagious.  We all have a rare opportunity to forge better, more loving relationships with our immediate family, or if you live alone, take the time to recharge and re-center yourself. Take full advantage of this moment and choose positive behaviors. Extend your empathy to those who are feeling ill if possible, through video chat, phone calls, texts, or prayer. This moment is so much bigger than just ourselves.

Turn off the news and turn on personal growth and connection. News reports are full of data, some of which are not accurate. Being addicted to the 24/7 news cycle breeds uncertainty and fear as it touts mostly negative statistics and woeful stories of the moment. The basics about this pandemic are well documented at this point. Practice proper hygiene, particularly with your hands, avoid touching your face, avoid large gatherings, and implement social distance but do not do this out of fear, do it as an act of service. Flip how your brain associates your daily choices by knowing that your actions are preventing the potential deaths of others.

Find something in media or on television that brings a smile to your face or makes you laugh. Break out the board games, cards, art projects, or walk outside (distant from others!) and get some sun. Sun provides vitamin D for your system, which also boosts your immune system. Whatever you choose, staying active and busy in a positive way will lessen any concern or fears that you are experiencing about the pandemic.

These points of view may all may read as cliché, but in 2009 Dr. Alvaro Pascual-Leone conducted a study consisting of two groups of people learning to play a simple piano melody. For five days, one group practiced the melody for two hours a day while the other group, over the same time, sat in front of the keyboard, imagining they were playing the melody. Dr. Pascual-Leone mapped the brain activity of the study participants before, during, and after the experiment, and the results were surprising. Both groups experienced the same brain changes. What this means is the brain does not differentiate between imagination and reality. What this also means is you have a choice, a choice to be riddled with anxiety, worry, and uncertainty or the opportunity to be courageous, bold, and confident by simply imagining those feelings. How you feel is a choice.

In simple terms, when you have a thought, your brain sends a pulse of electrical activity at the same moment. This electrical activity stimulates a release of neuropeptides that communicate with your body to produce a feeling. So truly, your thoughts create feelings. Activate your brain’s natural superpowers and boost your immune system by redirecting your brain’s thought patterns. Remind yourself daily to think positive thoughts, be grateful, and practice empathy which will give you the mental toughness to endure what still lies ahead.

We are open for business and would be happy to discuss any concerns you have. The pandemic we are living through has opened everyone’s eyes to the importance of having healthcare documents, as well as other planning documents like a will or trust.

If you have questions or need guidance in your planning or planning for a loved one, please do not hesitate to contact our office by calling us at (866) 456-9668.

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Keeping physical distance from others is one of the key tools in fighting the COVID-19 virus. Call or email us to find out how we can help you complete your estate plan without taking a single step outside your safe home.

Formerly, most states required that important legal documents must be signed in person. During the course of this epidemic, then, we have been doing all we can to follow that law, to get your documents signed in person and still protect your health.

Recently, however, an increasing number of governors have issued emergency orders to change that law. Ask us whether our state is one of those that has suspended the requirements for in-person signing. If so, we can offer you the entire estate-planning process, start to finish, all completed while you stay safe at home and connected with us by internet instead.

Please consider that especially under these circumstances, it would be most wise to get your plan done. You will have made sure that trusted people can step in for you, to take care of bills and health-care decisions if you become unable. At the same time, you will have taken care of your heirs, to protect your family’s legacy as smoothly as possible when the time comes.

How quickly things change. It may be that now we can do it all by internet, to get you to the peace of mind that doesn’t change. You will know that a trusted person can pick up the reins for you, so you or your loved ones get the care you need, and you will know that your estate legacy will be preserved and protected.

Contact our office by calling us at (866) 456-9668 to see whether we can get the whole process done using video. There’s nothing “remote” about that.

The post You Can Now Complete Your Estate Plan Online appeared first on Faloni Law Group.

It is essential that as your parents’ age, you have conversations with them about their finances. To broach the topic, you might bring up current events like the coronavirus pandemic, its effect on economic conditions, and how it relates to the security of their financial future. The conversation should come from a calming place of love and concern. Speak to them respectfully about how the coronavirus pandemic has you thinking about the importance of their planning and preparedness.

Once you begin the conversation, move away from the pandemic as your introductory technique as you do not want to create a sense of panic or fear.  Instead, delve into legal and financial reviews, processes, and parameters. US News reports that your parents’ financial analysis should include essential legal documents, financial accounts, and associated vital contacts, long-term care decisions, and claims. If you live apart, lay the groundwork to help them with their finances remotely.

It is generally most comfortable to begin your conversation with legal documents that hopefully your parents already have in place like a will, trust, living will, and a health care proxy. If your parents do not have these documents, they must retain an attorney and create the ones that best suit their needs. If you need to help your parents manage their finances, you must have a durable power of attorney. A durable power of attorney allows you to make financial decisions for your parents in the event they become incapacitated. This is an essential estate planning document. In the absence of a durable power of attorney, the courts become involved, and solving health or financial issues becomes a lengthy, expensive process over which you have little control. If your parents already have their legal documents drawn up, find out where they keep them and review them carefully. If any documents need to be amended, suggest that your parents meet with an attorney to make the relevant changes. Be sure their documents reflect the state law in which they reside.

Once you have assessed your parents’ legal documents, it is time for some financial discovery. Even if your parents do not currently need help, having an overview of their finances and a durable power of attorney to help them in the future is crucial to their aging success. Begin by listing all of their accounts, account numbers, usernames, and passwords as well as employee contact names. Include insurance policies, the agent’s name, and where the policy is, as well as how they pay their premiums. Include any online medical accounts or list their doctors’ names and office numbers. The idea is to create a comprehensive list of all of these accounts. Gather your parents’ Medicare and Social Security numbers and their drivers’ license numbers. Know where they keep this information so that in the future you will know where to look. Also, learn about any online bill paying or automated, re-occurring activity. These usually include monthly bills like electricity, natural gas, water, etc. but may also include quarterly payments or annual subscriptions.

If your parents still live in their long-time home, discuss if it is viable that they live out their days there, or if downsizing to a retirement community or moving closer to where you live appeals to them. Help them come to a decision that is best for their set of circumstances.  If they do not have long-term care insurance or some other mechanism to aid them in times of need, talk about the topic, and try to come up with a solution. If they do have long-term care, be sure you have a copy of the policy, contact information, and the name of the insurer and agent. Review the requirements for receiving benefits so you can help them when they need to file a claim as most policies have a waiting period of 30 to 90 days before benefits begin. Know what to expect.

Digital technology has made oversight of parents and their finances easier than ever as long as you have a durable power of attorney and access to their account information. If they do not yet pay their bills online, or use auto payment, help them set up this option for their monthly bills. Remind them you will provide oversight to ensure proper billing. Offer to help them with their annual tax filings. Your help relieves some pressure on them and provides you with information about the goings-on in your parents’ accounts. For your parents’ peace of mind, you can establish a monthly video chat to let them know their bill payments are progressing normally. Your involvement will allow you to identify any abnormalities in account activity, which may indicate scam attempts.

Having these financial and planning conversations with your parents today can help them live more securely and with less stress as they age. Most parents will try to avoid these discussions with their children because they may not be adequately prepared for what can lie ahead. Conversations that focus on proper legal documents and gathering financial account information will give you the data you need to help protect your parents.

We would be happy to help you and your parents with critical planning documents. We are open and taking new clients, and we hope to talk with you soon about your particular needs. Get in touch with one of our offices by calling us at (866) 456-9668.

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Millennials include fiscally conservative, savings oriented, and future planners seeking financial freedom as core attributes. A large part of millennials’ formative years was influenced by the US sub-prime mortgage crisis beginning in 2007, shortly followed by an international banking crisis, which led to what became known as the Great Recession. The millennial generation would have ranged from ages 11 – 26 years of age when this economic downturn began. Living through this economic volatility, not seen since the Great Depression, gave rise to the fiscally conservative millennial mindset. The other socio-economic force that continues to shape the millennial fiscal mindset is the student loan crisis. Cbinsights.com finds 41 percent of millennials carry student loan debt for which there is no personal bankruptcy relief. This debt crisis places unique financial pressures on nearly half of a generation, and many are seeking new ways to manage their income, debt, and future savings.

This conservative mindset has underpinnings of investment optimism about achieving financial goals according to reporting by the Union Bank of Switzerland Investor Watch report ( UBS ), and millennial goals are different from generations before them. The definitions of what being successful include a focus on personal success rather than maxing out returns on investments. This personal success is a balance of financial, relationship, and experiential factors, prioritizing long-term financial considerations like retirement or caregiving aging parents. Millennials understand their number one goal is to attain financial freedom, with a conscience. The UBS report goes on to say that 78 percent of millennials are more likely than other generations to believe income is a critical success factor and feel that income should be about 220,000 dollars to be considered a success. Millennials are also more apt to think money can buy happiness because their pursuit of money is geared toward financial freedom rather than excessive accumulation.

UBS Investor Watch Report

According to Forbes , many mid-life millennials (late 20’s and 30’s) are changing the order of, or opting out of traditional family and financial milestones of their predecessor generations. Some will have children before marriage; others will resolve all debt (think student loans) before entering into homeownership, and most will invest with sustainability and environmental concerns at the forefront of decision making. As the oldest millennials turn age 40 in 2020, many are conducting personal financial checkups, taking stock of their assets, liabilities, and insurance needs. Re-evaluation of and adjustments to financial plans help to ensure financial goals can be met.

Though most millennials do not yet have a professional financial advisor, ten self-directed steps can help to evaluate your current financial plans and make any necessary adjustments.

Millennials are at the cusp of their middle age planning stage of life and realizing that life’s priorities are a moving target.  While the above pertains to millennials, the importance of planning – both legal and financial – is critical at any age.

We help families of all ages plan for what is important to them, and to make sure their plans and wishes and properly documented. If you have questions about your planning, please don’t hesitate to contact our offices by calling us at (866) 456-9668.

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Age comes with wisdom. Unfortunately, it also comes with some forgetfulness. Fortunately, there are things you can do to keep the brain sharp, small daily habits which can reduce the risk of cognitive decline.

Exercise is one such daily habit. It increases blood flow, and thus oxygen to the brain; it also protects brain cells against destructive chemicals in the environment. Exercise also supports the production of new brain cells. Furthermore, research in the 2000s showed a relationship between cardiovascular risk factors and Alzheimer’s. Anything which can impair blood flow can cause strokes leading to cognitive decline, otherwise known as vascular dementia. The same activities that one would consider as beneficial to the heart, such as regular exercise, can therefore also be effective in protecting the brain. And, of course, there are other benefits to exercising regularly: it helps with energy levels, decreases anxiety and depression, and can help with sleep.

Sleep is another factor to maintaining a healthy mind. But as many as half of adults 60 and older are affected by insomnia, which can result in memory loss, depression, and other symptoms. It’s important, then, to pay attention to sleep hygiene and sleep schedules to ensure sufficient duration and quality. If it takes more than 45 minutes to fall asleep, or you have trouble staying asleep, it may be worth looking into treatment.

Eating well is another way to protect the mind. It’s important to ensure you’re getting enough vitamins A, B, C, D, E, folic acid and niacin. The USDA and the HHS describe two eating plans: the USDA food patterns or the DASH Eating Plan. Foods like nuts, fish, and wine have also been linked to a healthy brain.

Art, music, reading, writing, learning, and puzzles… these are also good for keeping the brain sharp. Art has been used as an Alzheimer’s treatment and to restore memory; and arts maintain and improve dexterity and fine motor skills! Adult coloring books have become popular in recent years and can be found in many stores and online; watercolors and pastels are also relaxing.  Meanwhile, music has been linked to improved memory and cognition, and can both elevate your mood and lower blood pressure. Learning and intellectual challenges like puzzles exercise the brain and improve its capacity. Mental exercise is thought to maintain and stimulate brain cells. This includes pursuit of hobby, learning new skills, using brain training apps, or taking on other new kinds of projects at work.

If you have questions or need guidance in your planning or planning for a loved one, please do not hesitate to contact one of our six office locations by calling us at (866) 456-9668.

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Contemplating our own death is one of the hardest challenges we will ever have to face. Yet, if we want our dying to be meaningful and merciful, it is imperative that we think about it while we still can. Most of us want to die at home, in a familiar and peaceful setting surrounded by loved ones. We would much rather not spend our last moments in an emergency room or ICU, with strangers futilely pounding on our chests and our families relegated to the waiting room.

With those two alternatives in mind, we need to do all we can to keep control, as much as possible, of decisions that need to be made long before our final moments. We need to think carefully, well in advance, about what makes life worth living, and where pain and limitation have so eroded that quality of life that we would prefer not to go there.

These are notoriously difficult questions, but it is vital to address them anyway. For example, Terri Schiavo spent nearly half her young life unconscious in a condition known as a “persistent vegetative state,” being kept alive by a feeding tube. Her husband and friends claimed that before her severe brain injury, she said that she would not want her life sustained by machines. Unfortunately, she never put that wish in writing. On the other side, her devout family and right-to-life supporters insisted that she be kept alive despite her dire condition. After protracted litigation, Ms. Schiavo’s husband prevailed, the feeding tube was withdrawn, and, fifteen years after she was injured and never having regained consciousness, she was finally allowed to die.

Since her passing, the law has evolved nationwide to encourage us all to document final wishes, to avoid the anguish and uncertainty of Ms. Schiavo’s situation. There are a number of documents available in your state for that purpose. The umbrella term for these is “advance health-care directives.”

It’s our job as lawyers to help you sort through the various directives needed to express your wishes. Here is a step-by-step guide to begin the conversation about final wishes, and to understand which document does what when.

If you are over the age of 18, appoint a health-care agent to speak for you when you can’t.

Decide who, among those who know you well, is best suited to take on this responsibility. That person must possess good communication skills, remain calm in difficult situations, and be able to deal flexibly with complexity that might arise in reconciling your wishes with available medical options. Depending on which state you live in, your agent can also be called a “health care proxy.”

Sit down with that person and discuss your wishes in various scenarios. This is not an easy conversation to have, but there are guides available to help you. Visit “ The Conversation ” and download the starter kit.

Health Care Power of Attorney (HCPOA)

Once you have had that conversation, visit your lawyer to name your agent formally  in an HCPOA document. HCPOA conveys legal authority on your agent or proxy to express your health-care decisions when you are unable to.

HIPAA authorization

Your agent or proxy will also need access to your otherwise-private medical information. This is best done by a standardized document that complies with the federal Health Insurance Portability and Accountability Act (HIPAA). Without this authorization, your agent will be unable to obtain the medical information necessary to exercise the authority you want him or her to have.

Now armed with your agent and the HCPOA and HIPAA documents, you will know that if you were to meet with an accident or lose consciousness, you have chosen and empowered an advocate to speak for you. You should review and update these documents every five years or so.

The next three documents are important at the end of life. All these documents should stipulate that you desire comfort care, to keep you clean and as pain-free as possible. Remember, though, that you must create these documents while you are still able to know and communicate your wishes, so it’s best to do the next two documents at the same time that you do your HCPOA and HIPAA.

Living Will (also known as Physician’s Directive)

This document is for use when you are not enjoying quality of life. Either death is imminent; you are in a persistent vegetative state; or you are permanently unconscious, permanently confused, or unable to care for yourself. If you have no awareness of others; can’t remember or understand or express yourself; or are unable to move, bathe, or dress yourself, it’s advisable to have expressed, in advance, the kind of treatment you want to receive or not receive.

A living will expresses your choice as to whether you do, or do not, want artificial measures that will merely prolong your life but not improve it. Those measures, among others, may include CPR if your heart stops, or breathing or feeding tubes, or repeated courses of antibiotics or chemotherapy.

You may also require physicians, and not your agent, to be the ones to decide whether to cease life-prolonging procedures as you would like. This decision will relieve your agent from the heavy responsibility of making that irreversible choice.

Living wills are legal in almost every state. Ask your lawyer. Don’t make this kind of document yourself. Otherwise you risk that the document may be misinterpreted, with drastic consequences.

Specialized Directives

Medical decision-making varies depending on specific health conditions, so specific directives may be tailor-made for those conditions. For example, people suffering from advanced dementia benefit from a directive, in addition to the HCPOA or living will, specifically requesting that hand-feeding be ceased when the person can no longer speak, recognize loved ones, or move purposefully. Otherwise, caregivers are obligated to cajole or demand that the patient be fed by hand, taking advantage of a primitive reflex to open the mouth. This risks that the person may inhale the mush instead of swallowing it, in some cases causing pneumonia.

For this kind of condition, ask your lawyer to prepare a specific directive tailored for advanced dementia, using the directives created by End of Life Washington or End of Life Choices New York.

If, however, you suffer from a neurological illness like Lou Gehrig’s disease (ALS) or advanced Parkinson’s, even though most of us would decline mechanical treatments, those same treatments may be important aids to preserve quality of life for people with those conditions.

Again, remember that you must create these documents while you still have the capacity to communicate your wishes. Living wills should be reviewed every six months, because wishes can change depending on the progress of the illness.

POLST or MOLST

This is a brightly colored, short-form document that is primarily intended for emergency responders when the patient is frail and is likely to die within a year. It is designed to be immediately recognizable by hospitals and EMS personnel, to express that when the patient is unresponsive, cardio-pulmonary resuscitation (CPR) and other aggressive treatments are desired or not desired (DNR).

This document should be filled out in consultation with the patient’s physician. The acronyms stand for “physicians’ orders for life-sustaining treatment” or “medical orders for life-sustaining treatment.”  Many states provide for this kind of document.

MAKE YOUR DOCUMENTS KNOWN

When it comes time to use your documents, they must be readily available. Give a copy of them to your agent or proxy, make sure they are included in your medical records, and, if you are in need of the POLST or MOLST, post it beside your bed or on your fridge where EMT knows to look for it. If your documents can’t be found, or if your agent or family don’t understand them or ignore them, you will have spent your time, effort, and money in vain.

But if all goes according to your wishes, you will have done your best to create a good death, one that is as meaningful as possible for all concerned.

If you have questions or need guidance in your planning or planning for a loved one, please do not hesitate to contact one of our six office locations by calling us at (866) 456-9668.

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Life plan communities, often referred to as continuing care retirement communities (CCRCs), are an increasingly popular choice of aging Americans. These communities offer the array of care options necessary as seniors move through the stages of aging that include independent or assisted living, memory care, and skilled nursing. Beyond health care CCRCs offer a wide range of services “such as housekeeping, dining options, transportation, fitness and wellness programs, recreational activities as well as social activities and outings for residents.” It is essentially “aging in place” except in a community environment. There are approximately 2,000 CCRCs in the country as compared to about 30,000 assisted living facilities primarily because the price of a CCRC is about $3,000 to $5,000 a month. If you can and are considering joining a CCRC, there are some parameters to consider very carefully.

The first consideration is financing. Can you afford the buy-in and associated monthly fees? If necessary, a senior is allowed to convert home equity and other assets into their initial expenditure to join a CCRC however, the vast majority of seniors who choose to reside in a CCRC have the personal financial resources to fund the stay out-of-pocket. All facilities and contracts are different. Each state has an agency that regulates CCRCs, and the government entities offer listings and a consumer guide about the CCRCs available in your state. There is also an independent nonprofit organization called CARF International , which provides accreditations for CCRCs and their services.

Overall, you will not be able to use Medicare to cover the cost of a CCRC because Medicare Services do not cover long-term care. The exception for Medicare coverage is if you use skilled nursing services while in your CCRC facility; Medicare will cover up to 100 days of that service. Because these CCRC contracts are similar to a “long-term insurance plan” it is tax-deductible because the IRS considers it a prepaid medical expense. The financial picture is different for every individual and every facility so get with your financial planner and elder law attorney to carefully review the contract and its terms before committing to anything.

While every CCRC is different, there is some standardization in the three types of contracts that are typically offered. The first is an all-inclusive, fixed price contract. While it is the most expensive contract, it provides unlimited access to all of the assisted living, medical care or skilled nursing care at no additional charge. This contract is best for someone entering the facility while still healthy and independently able. The second option is a modified contract that provides services for a set length of time which is a gamble. In the event you outlive the contractual timeline the additional services required are likely to expose you to a higher monthly fee.  The third type of contract is a fee for service which means you only pay for the services you use. Fee for service contracts typically lowers your entry cost into the community, but you will pay market rate for assisted living or skilled nursing care if you need those services.

The best time to make a move into a CCRC is when you are healthy and able to take advantage of all the facilities have to offer. Being in a community that provides health and wellness strategies above and beyond medical care can allow you to age more successfully and with fewer health incidents. Moving into a CCRC is not a decision to be made in desperation because of an urgent health care need. The complexity and range of the CCRC contracts and pricing options need your careful thought and review with professional guidance to optimize your aging experience. Seniors with a spouse find a CCRC living choice particularly gratifying because partners will need different medical help at different rates. Even if the couple is not living in the same unit due to medical conditions they are at least on the same campus.

The social and activity amenities offered in CCRCs are very interactive and keep residents engaged. However, if the location of the campus is remote from urban environments, you might feel isolated and disconnected from the world at large. Some CCRCs are popping up in downtown locations and even on college campuses around the country. So be certain when considering a move to a CCRC you ask yourself if the site appeals to you for the long term. Also, find out how far removed it might be from family members you want to visit with often.

There are many questions to ask when contemplating a move into a continuing care retirement community. Visit the property and bring a family member or legal counsel to ensure the proper inquiries are made and that answers are complete. Ask to spend a week at the facility to experience it firsthand and avoid buyer’s remorse. You are deciding whether to reside at a property for the rest of your life and must be sure that the facility is a fit for you. Because there have been bankruptcies in the CCRC business sector, you must review the facility’s financial sustainability. You do not want an unsuccessful CCRC to force you into a relocation process late in life that can be financially, physically, and emotionally draining.

If you have questions or need guidance in your planning or planning for a loved one, please do not hesitate to contact one of our six office locations by calling us at (866) 456-9668.

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