Planning for Life

Why Must Centenarian Resort to GoFundMe to Pay for Home Care?

Posted by Harry S. Margolis on July 6, 2021

By Harry S. Margolis

The Boston Globe reported that Juliet Bernstein, a Cape Cod resident who turned 108 years old last Friday, has raised $72,000 on GoFundMe to pay for her home care. Since the article ran, she has raised another $50,000.

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Ms. Bernstein has had to resort to this source of funding because neither Medicare or MassHealth will pay for her care and her children don't have the means to contribute more than they have already. She has taken out home equity loans on her home and her oldest daughter, who is 80 years old herself, has taken out a reverse mortgage on her own home to help pay for her mother's care.

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Topics: MassHealth planning, MassHealth, home care, estate recovery

'Take Me Out and Shoot Me' Plan Leads to Family Squabble

Posted by Harry S. Margolis on June 7, 2021

By Harry S. Margolis

elder-care-attorney-long-term-care-planning-Wellesley-MA-02481

Several years ago, I acted as mediator in a family dispute resulting from the failure of a senior and her family to plan ahead for her potential disability. At the time, she was disabled and living with one daughter who, with her husband, hired caretakers to take care of her mom. The dispute was over how much of the mother’s estate should go to the daughter and her husband for the sacrifice they were making.

Marilyn's Long-Term Care Plan

The mother, who I will call Marilyn, made no plans for her possible need for long-term care. Her family reports Marilyn to have said that she would never go to a nursing home and if she ever had to, her family should “take me out to the backyard and shoot me.”

After her husband died, Marilyn was living alone in the family home and was very lonely. She and one of her daughters, who I will call Nancy, agreed that Nancy and her husband would purchase a larger house with financial assistance from Marilyn so that they could all live together. While there was some discussion of how the finances would work and what would happen if Marilyn needed care. Everyone was counting on everyone else’s good faith.

Nancy and her husband purchased the larger house. Marilyn moved in and paid about half of what would be her share of the purchase price based on the size of the in-law apartment she occupied. Then, unfortunately, she became ill and needed increasing levels of assistance. Nancy had to give up her part-time job and there was a great strain on the entire family caring for Marilyn.

Family Disagreement

Nancy’s brother and sister appreciated the sacrifice Nancy and her family made and agreed that she should be compensated as a result, but they couldn't agree on the extent of such compensation.  Nancy was offended by suggestions that some of what she did was simply what daughters do for mothers and shouldn’t be fully paid for.

The biggest disagreement was over what would happen after Marilyn's death, since at that point Nancy and her husband would be living in a bigger house than they would need or could have afforded on their own without Marilyn's contribution.  Nancy and her husband saw large financial costs and risks in living in this bigger, more expensive house. Nancy’s brother and sister saw Marilyn’s money — all of which might disappear in payments to Nancy and paid caregivers — as helping Nancy and her family have a bigger, nicer house than they could have had on their own. And these decisions were made among Marilyn, Nancy, and Nancy’s husband without the participation of Nancy’s siblings, who were presented with a fait accompli.

Given the different perspectives, some hurtful comments were made in the negotiations causing feelings that caused a rupture in the family. (It didn't help that Nancy was rather dogmatic about how to go about caring for Marilyn. While it's often true that the child on the scene knows the situation better than other children in other parts of the country who may have ill-informed, but strong opinions about the care the parent should receive, in this case Nancy refused even to consider alternatives that might reduce the cost of caring for Marilyn.)

Plan Ahead and Put it in Writing

While there are no guarantees, it is more likely that this could have been avoided had Marilyn planned ahead and if the entire family had been involved in the planning. While it often works well for older family members to move in with their children, or vice versa, a full discussion of how the living arrangement will work when and if the parent begins to need care could help avoid problems in the future.

It also helps to put the plan in writing for several reasons. First, it makes sure everyone is in agreement or brings disagreements or different understandings into the open. Second, it serves as an aid to memory, since years later different people may have different memories of what they had discussed and agreed to. And, third, the act of putting decisions in writing raises issues that the parties might not have considered otherwise. It's better that these be discussed earlier rather than later.

But even with a written plan, everyone needs to be flexible. Unanticipated situations arise and circumstances change. The child who agreed to take the parent into his house may not be able to do so if he moves across country due to a new job opportunity, or gets divorced, or faces his own medical challenges.

 

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MassHealth Planning and Real Estate

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Topics: family dispute, family caregiver agreement, family caregiving, home care

Move Out of Your House Before It's Too Late!

Posted by Harry S. Margolis on May 25, 2021

By Harry S. Margolis

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According to an AARP study, 76% of Americans age 50 and older want to remain in their own homes as they age. But they're not totally unrealistic about this. Just 46% expect to do so. Yet, the reality is that this will be difficult for most, if not for them, then for their caregivers.

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Topics: baby boomers, caregiving, healthcare, home care

Pandemic Highlights Caregiver Crisis, Biden Bill a Step to a Solution

Posted by Harry S. Margolis on April 20, 2021

By Harry S. Margolis

As we have discussed before, the number of Covid-19 deaths in nursing homes has brought to light the ongoing crisis in how we care for our ailing seniors. In short, the problem is that we've always been trying to do so on the cheap through the Medicaid (MassHealth in Massachusetts) program. As a result, caregivers in nursing homes are underpaid and most facilities are understaffed.

Low Pay Affects Quality of Care

A recent report, which is summarized in The New York Times, describes how the low pay and stress leads to turnover of nursing home staff. That turnover affects care both because it means that most caregivers are inexperienced and they and the nursing home residents don't know one another. This can be especially confusing for those residents who suffer from dementia.

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Topics: nursing homes, Caregivers, home care

GAO Reports Home Care Workers Still Underpaid Despite New Protections

Posted by Harry S. Margolis on November 9, 2020

By Harry S. Margolis

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Over my 30-plus years practicing elder law, the nature of elder care has changed dramatically, from one that was nursing home-based to one where care is largely provided at home or in assisted living facilities. (Of course, then and now, most care is provided by family members at no cost. Actually, "no cost" is wrong. No dollars may change hands, but the care is often provided at great cost to the caregiver.)

A great weakness of our "system" for providing elder care is that despite its great cost, most care providers are drastically underpaid. This has detrimental effects on them as well as on the people for whom they care due to the resulting stress and fatigue on caregivers and their turnover as they seek other ways to earn a living. One result has been the huge number of coronavirus deaths in nursing homes across the United States, but especially in Massachusetts. (See Deaths in Nursing Homes: How We Let Down Our Older Citizens.)

In an effort to ameliorate this situation, in 2015, the U.S. Department of Labor, for the first time, extended minimum wage and overtime protections to home care workers. Unfortunately, a new Government Accounting Office (GAO) study reports that this has done little improve the income of most home care workers, in part no doubt to the low federal minimum wage of just $7.25 an hour in 2020. Home care workers in 2019 earned a median income of just $400 a week—just $10 a week more than the average income for jobs with similar education and training requirements. Median means that half such workers earned less than $400 a week!

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Topics: baby boomers, home care

Enhanced Unemployment Benefit Protects Caregivers and Families

Posted by Harry S. Margolis on July 28, 2020

By Harry S. Margolis

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As you no doubt know, the Cares Act enhanced unemployment benefits of $600 a week are slated to end on Friday, July 31st. There's a debate about whether to extend them based on many factors, including the need to keep the economy functioning during the pandemic, the risk that many renters will no longer be able to pay rent and many homeowners will default on their mortgages, what the nation can afford, and the argument that some workers are staying home because they're making more from unemployment than they would from working.

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Topics: caregiving, home care

Should Seniors Downsize or Age in Place?

Posted by Harry S. Margolis on May 7, 2019

By Harry S. Margolis

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While everyone's desires and circumstances are different, most people upon retirement or later face the issue of whether to stay in their homes or move, whether to a smaller house or apartment, to a 55 and over community, or to get out of northern winters. Some people want relief from the headaches and expense of maintaining a house, not to mention the lawn in front, while others don't want to leave the home or community where they've lived for decades and raised their families.

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Topics: the accessible home, housing policy ,, home care

Home Care Benefits and Risks

Posted by Harry S. Margolis on October 2, 2018

By Harry S. Margolis

home-care-for-seniors-caregivers-elder-law-attorney-Wellesley-MA

In recent years, home care for disabled seniors has grown tremendously with absolutely no regulation. For the most part, this has been good, with millions of seniors being able to stay in their own homes as they age. But a recent series of articles in The Boston Globe highlights the risks inherent to the system both to those receiving care and those providing it.

There has been a proliferation of individuals and companies, small and large, either providing in-home care or connecting families with caregivers. Two of the biggest are Home Instead Senior Care, which franchises home care agencies, and Care.com, which has expanded its child care referral services to include senior care as well.

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Topics: Caregivers, elder care, home care

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