Category: Caregivers Resources

Seniors, Mental Health and Firearms: A safety plan.

On By Jane Fearn-Zimmer, Esq.In Caregivers Resources, UncategorizedLeave a comment

As of July 16, 2022, the suicide prevention and crisis hotline can be reached by dialing 988 in New Jersey (and nationwide.) There is also a chat feature. The 1-800-273-8255 hotline will continue in effect.   You can find additional details online at Department of Human Services | 988 Suicide & Crisis Lifeline (nj.gov).

Sadly, suicide affects people of all ages. It is a leading cause of death among white males over the age of 65.  Approximately 15 individuals pass away from this daily. The use of firearms is a leading contributing factor.  See James H. Price, Jagdish Khubchandani, Firearm Suicides in the Elderly:  A Narrative Review and Call to Action, Journal of Community Health 46:1050-1058 (February 5, 2021).  The full study is available online at Firearm Suicides in the Elderly: A Narrative Review and Call for Action | SpringerLink. Letters Against Isolation | Write letters to Self-isolating seniors.

This is not a political statement. Many seniors have firearms for protection and sport. When not in use, guns should be locked away, preferably in a gun case. You may want to reconsider keeping a firearm in the home of a senior with a serious vision impairment (i.e., blindness or macular degeneration), a condition which will impair coordination (i.e., multiple sclerosis, Parkinson’s Disease, cerebral palsy, stroke with paralysis, traumatic brain injury, and brain tumors) or a diagnosis or signs of dementia, confusion and/or cognitive impairment (i.e., Alzheimers and/or vascular dementia). Article for Gun Ownership & Safety Tips for Seniors

What are the societal factors driving these grim statistics? The elderly are confronted with physical and mental illness, isolation, loss of independence in the home, family and friendships, and must navigate life without any sense of meaning or productivity usually provided by gainful employment. They must face their struggles with limited income, limited financial resources and limited social support.  They are often invisible in our media.  Unlike younger adults, older individuals facing overwhelming challenges may be less likely to hang in there, until the situation improves for them. 

What You Can Do To Help.

These problems are a wake-up call.  What can we do to better the situation?   A good place to start is with little things. If you are so inclined, you could make a donation to non-profits that fight hunger, such as Feeding America and Meals on Wheels. Some churches have casserole programs, where you can prepare an extra meal, freeze in a foil container, and donate it to your local church or soup kitchen. Fostering a sense of connection is another way to help. It doesn’t take much to make a telephone or Facetime call, send a short note or card, share a meal, or to express your thanks to a loved one who helped shape you into who you are today. If your parents and grandparents are no longer with us, I am sorry for loss, but you are not off the hook! If you want to help and are inclined to write, consider volunteering with a cause like Letters Against Isolation, which fights senior loneliness with letters to bring joy. For more information, visit https://www.lettersagainstisolation.com/.

National Caregiver’s Day: A Look at Elder Care in the Age of COVID-19

On By Jane Fearn-Zimmer, Esq.In Caregivers Resources, Elder Law, Elder Law & COVID-191 Comment

It’s National Caregiver’s Day, and another year filled with countless and unimaginable changes has passed. This year especially, my heart goes out to caregivers and their loved ones everywhere! Even before the COVID-19 pandemic, caregiving was no bed of roses. But this year, caregivers are facing an onslaught of new challenges, not the least of which are combatting senior isolation and reduced access to face-to-face therapies and delayed medical examinations. 

How has the COVID-19 pandemic changed care options?  Adult medical day care centers are not providing in person care at their customary location but may deliver services via telehealth and in person visits in the home. This leaves care in the home and care in a long-term care facility as the remaining options for senior care.  

The long-term care industry has been hard hit by the pandemic. From a medical standpoint, until the pandemic subsides, full-time care in the home is probably the safest option. A good option for private care in the home would be hiring a home health aide through an agency.  Benefits of a full-time caregiver (whether hired or by a loved one) include stronger protection of the vulnerable senior, since the caregiver is not moving from home to home (or from home to a nursing home) caring for multiple patients in multiple settings. It can also give the family members or friends who are overseeing the care an opportunity to recharge, which is important to prevent burn out. The right caregiver can provide social companionship to the senior.  

Families considering this option will want to keep in mind that the cost of private, hired live in care will include the cost of groceries for the home health aide, as well as worker’s compensation insurance if the caregiver is providing only companion and housekeeping care. . In such cases, the homeowner’s carrier should be put on notice of the arrangement and the family should work with an accountant to ensure that an accountant or payroll company to ensure compliance with withholding and state insurance requirements. The home’s layout should include a private area with a door that closes for the caregiver, who will need to rest and recharge while the senior is sleeping.  An employment agreement with the caregiver can protect the homeowner and the employer’s rights and ensure that minimum wage and hour requirements are met. If the senior needs care from a certified home health aide, keep in mind that such care can only be provided through a licensed home health care agency with a nurse supervising the implementation of the doctor’s plan of care. Hiring a caregiver to provide such comprehensive care outside of an agency is illegal and potentially places the senior’s well-being at risk.  Agencies do screen their prospective employees, and may be able to identify unsuitable caregivers.  If the caregiver is willing to break state law, how amenable will the caregiver be to calling 9-1-1 if the senior needs emergency medical care of doing so means the caregiver is risking getting caught breaking the law?  The family may expect to save money with an unlicensed, under the table caregiver arrangement, but in addition to being illegal, the fallout from such arrangements tends to be extremely expensive and can take a terrible toll on the senior’s health.  

Another option is care in the home financed through the Veteran’s Special Improved pension/Aid and Attendance, which is a government benefits program for eligible United States military veterans or their surviving spouses to help defray the cost of care.  In cases where the senior qualifies for Medicaid, and is able to remain in the home, programs such as the Personal Preferences Program (PPP), “can provide a source of funding for the senior to choose and hire their preferred caregivers, which can include relatives and friends.” Under the PPP program, the senior chooses the services and schedule they desire. 

The remaining option is care in a long term facility. This may be the best option where the care recipient is a two person assist, has behavioral quirks, or requires a team of trained medical professionals to stabilize and maintain their condition.  In some situations, Medicare dollars can be used for limited periods of time as “key” money to admit the senior to the best facility possible, with the goal of later transitioning to payment for the best care through the   Medicaid program and the senior’s income. 

These are just a few important considerations. For help sorting through your options, consultation with an elder law attorney is recommended.  

For more information about elder care in the age of COVID-19, please feel free to reach out.

Jane Fearn-Zimmer is an Elder and Disability Law, Taxation, and Trusts and Estates attorney. She dedicates her practice to serving clients in the areas of elder and disability law, special needs planning, asset protection, tax and estate planning and estate administration. She also serves as Chair of the Elder & Disability Law section of the NJSBA.

Some Practical Steps You Can Take to Protect Your Loved Ones from Elder Abuse

On By Jane Fearn-Zimmer, Esq.In Caregivers Resources, Elder LawLeave a comment

Every year, the United Nation marks a special day to raise awareness of elder abuse, which is very prevalent, especially among individuals over the age of 60 with dementia.

America is, at heart, a nation built by patriots, immigrants and pioneers. At our core, we are people who are willing to fight and die for freedom.  We cherish our freedoms, especially the freedom to live independently.  Most adult children want to keep their parents at home as long as possible. Out of love and respect, they may hesitate to ask personal questions about their parents’ finances, legal documents, medical conditions and care, and who is coming in and out of their parents’ home when their adult children are not present.

The ugly truth is that unless a care plan is put into place and carefully managed, with appropriate checks and balances, staying home alone can be isolating and can expose an individual, especially one living with dementia, to a heightened risk of abuse.  I am not just being alarmist.

Consider what happened in the actual case of Sally Dinoia. In the matter of the guardianship of Sally Dinoia, Docket No. A-5276-17T3 (N.J.App.Div. December 26, 2019). Sally was 85 years old, widowed with several children, and was living in her former marital home with her adult son, John.  John had cared for her for years.  Someone raised a concern about Sally’s well-being and Adult Protective Services (APS) investigated. She was noted to have poor hygiene, fungus and bug bites on her body.  Bedbugs were discovered in her home and on her person. An exterminator was called to treat her home, but John refused to let the exterminator inside. John interfered with the attempts of a physician to examine his mother and filed litigation against APS and the local police, which were both responsible for various aspects of the investigation into his mother’s welfare.

The APS failed to investigate Sally’s finances as required. Eventually, a guardian was appointed for Sally, and that guardian was faced with the colossal task of opposing John, who was extremely litigious, in court. In the process, counsel for the guardian racked up a legal bill of over $43,000, which Sally had no money to pay. APS, which did not investigate as it should have, was ordered to pay the bill, resulting in an appeal brought by APS to overturn the judge’s order requiring APS to pay Sally’s bill.

As you can see from Sally’s case, trying to clean up the elder abuse can be like trying to wade through quicksand.  A much better option is to put a plan into place at the first moment you are reasonably sure that something more than ordinary aging or an adjustment reaction to a stressful situation is responsible for your aging parent’s memory or behavioral issues.

Here are some important steps you can take to prevent elder abuse before it happens.

  • Make sure you have legal authority to act on behalf of your aging parent. Like insurance, it’s a bad idea to put off getting it until you need it. If possible, get a power of attorney in place for financial or medical purpose.  If your parent can no longer sign a power of attorney or is unwilling to do so, apply for a guardianship or conservatorship without delay.  Don’t wait until after there is a problem to get legal authority in place.
  • Review their finances. This includes their health insurance and their eligibility for public benefits, such as the Veteran’s Improved Pension and Aid and Attendance and Medicaid. Is your parent signed up for Medicare when first eligible? Does he or she have a Medicare supplemental plan or a Medicare Part D plan?
  • Work with their doctor to put a care plan and supports in place. The goal is to limit the parent’s decline.  You can’t make your parent young again, but you can help them live their best life at home as long as possible.  Enlist the services of a geriatric care manager to make sure that the home environment is safe and to make appropriate referrals to the services and supports your parent needs.
  • Get affordable care in the home through an agency. I am a fan of home health care agencies.  They screen the care providers, handle payroll, income tax reporting, and are licensed and bonded.  They can send a replacement quickly if needed.  Having multiple team members in the home can provide your aging parent with social stimulation and enough oversight.  There is also safety in numbers.  An aging parent is less likely to be a target of abuse if he or she is surrounded by several other individuals. A care team by its nature can provide a built in system of checks and balances.
  • Work with an elder law attorney. They can help you ensure that your parent has the best care and that your parent is able for that care for the rest of his or her life, using public benefits if necessary.

Questions? Let Jane know.

Jane Fearn-Zimmer is an Elder and Disability Law, Taxation, and Trusts and Estates attorney. She dedicates her practice to serving clients in the areas of elder and disability law, special needs planning, asset protection, tax and estate planning and estate administration. She also serves as Chair of the Elder & Disability Law section of the NJSBA.

Getting the Most out of your ABLE Account Based on the SSA’s New Guidance

On By Jane Fearn-Zimmer, Esq.In ABLE accounts, Caregivers Resources, Elder LawLeave a comment

ABLE Program in New Jersey

The Social Security Administration released a new update to its Procedure Operations Manual System, (POMS), effective March 13, 2020.  This is a very important development because the POMS is the manual used by employees of the Social Security Administration in processing claims.  The new provision gives additional information about the types of expenses an ABLE account’s proceeds can be spent on, for a qualified, disabled beneficiary, while still retaining that beneficiary’s eligibility for Medicaid and other means-tested public benefits, like Supplemental Security Income (SSI), Section 8 housing benefit. Heating assistance (LIHEAP), and food stamps (Supplemental Nutritional Assistance Program (SNAP)).  In particular, the new guidance clarifies that food purchased with an ABLE account’s proceeds can be a qualified disability expense.

What is an ABLE account?  It’s a special, federal income tax qualified disability savings account, the balance of which is disregarded in computing eligibility for public benefits, so long as it remains below set levels.

Who can benefit from an ABLE account? Only a qualified disabled beneficiary can benefit from an ABLE account. A qualified disabled beneficiary is an individual who is eligible for Supplemental Security Income (SSI) on the basis of blindness or a disability, where the individual’s blindness or disability was incurred prior to the age of 26.  Another route to qualified disabled beneficiary status is entitlement to disability insurance benefits, childhood disability benefits, or a disabled widow or widower’s benefit on the basis of a serious, disabling condition that began prior to age 26.

Are there other exceptions to qualify for an ABLE account? An individual may be eligible for an ABLE account on the basis of a certification that the individual has a medically determinable impairment meeting the statutory criteria for a disability determination (i.e., marked and severe functional limitations) or is blind, and the blindness or disability was incurred prior to age 26.

Distributions can be made out of the account for certain qualified disability expenses. To the extent that the balance in the ABLE account:

  • Does not exceed the $100,000 SSI limit, and
  • Distributions are made in the same calendar year as they are used to purchase qualified disability expenses for the disabled beneficiary, the income from the qualified distributions may be offset by deductions for the qualified disability expenditures paid in that same calendar year.

It is important to note that if the qualified disabled beneficiary does not receive SSI, then he or she is not subject to the $100,000 SSI threshold, but the qualified disabled beneficiary must ensure that the funds in the ABLE account remain less than the 529 contribution amount for his or her state of residence.

What are the benefits of an ABLE account? The benefits of an ABLE account come with the quid pro quo that the funds on deposit in the ABLE account after the death of the disabled beneficiary and after the payment of all outstanding qualified disabled expenses will be subject to a Medicaid payback for all expenses incurred by the state (or states’) Medicaid agency on behalf of the disabled beneficiary after the date of establishment of the ABLE account.

* Please note that during the period of uncertainty due to the COVID-19 pandemic, there may be delays in communications and services from ABLE PLAN providers, due to remote work arrangement and contingency work plans. However, basic services and information should be available through online access.

What are qualified disability expenses? These may include:

  • Education
  • Housing
  • Transportation
  • Employment training
  • Assistive technology
  • Personal support services
  • Health, prevention and wellness
  • Financial management and administrative services
  • Legal fees
  • Expenses for oversight and monitoring
  • Funeral and burial expenses
  • NEW: the purchase of food is now considered a non-house related expense

Why is the new guidance important? While much of the new guidance reiterates settled rules, the new guidance is important because it clarifies that food may be purchased with funds from an ABLE account and such purchases will be treated as a non-shelter related qualified disability expense and disregarded for purposes of determining eligibility for the SSI (and other means-tested federal benefits).  The distribution from the ABLE account, to the extent used to purchase food, will not be considered in kind support and maintenance and therefore, will not place the individual in excess of the SSI income limit.  The ABLE account beneficiary will not be disqualified for the SSI benefit and will not suffer a reduction of the SSI benefit amount due to in kind support and maintenance.

Questions? Let Jane know.

Jane Fearn-Zimmer is an Elder and Disability Law, Taxation, and Trusts and Estates attorney. She dedicates her practice to serving clients in the areas of elder and disability law, special needs planning, asset protection, tax and estate planning and estate administration. She also serves as Chair of the Elder & Disability Law section of the NJSBA.

National Caregivers Day, February 21, 2020: An Expression of Appreciation

On By Jane Fearn-Zimmer, Esq.In Caregivers Resources, Elder LawLeave a comment

national caregiver Day 2020

These days, it seems that everywhere I turn, I find caregivers working with unselfish devotion to the people they serve. Caregiving can be formal (i.e., health care professionals working in the hospital, long-term care and hospice industries) or informal (i.e., family members providing care in the home) but it is always an act of service. In honor of National Caregivers day and all the hard working caregivers serving seniors and the disabled, here is a special blog to express my appreciation and thankfulness for all you do!

Working with individuals with dementia can be very physically and emotionally demanding.  That is why self-care is so important.  While paid caregivers may have access to training and co-workers to support them, unpaid caregivers seldom have these resources. Fortunately, for those seeking guidance on how to identify and redefine their needs and responsibilities as unpaid caregivers in the home, there is a helpful book filled with practical tips on the subject. Your Caregiver Relationship Contract (2019), by Debra Hallisey, is available through Amazon.  Her book offers a peaceful framework for caregivers to change an established relationship with a parent who still regards the child caring for them as their little one, not an adult with needs and obligations of her own.  Topics covered include how to deal with guilt and anger, setting boundaries, building a support network and strategies for difficult conversations. Here are some of the tips Ms. Hallisey shares:

  • Start important conversations in the car or while sharing an intimate experience with the person you are caring for, such as baking together or combing hair.
  • Bring up a topic up multiple times in varied settings and eventually your loved one’s no may become a yes.
  • Use “I” words (I need help) and don’t blame.
  • When setting a boundary, be honest and direct. Start the conversation with an expression of caring.
  • Use words that validate your loved one’s choices. Words and tone of voice matter.
  • Compassion fatigue is real. Combat it through self-care.

Questions? Let Jane know.

Jane Fearn-Zimmer is an Elder and Disability Law, Taxation, and Trusts and Estates attorney. She dedicates her practice to serving clients in the areas of elder and disability law, special needs planning, asset protection, tax and estate planning and estate administration. She also serves as Chair of the Elder & Disability Law section of the NJSBA.