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Use Multiple Sources for Caregiving Help

January 21, 2009 By Jacqueline Laurette Jones Leave a Comment

Middle class families usually don’t qualify for much help with caregiving. Home health agencies teach you how to do your part more efficiently. That won’t help if there aren’t enough people in your family or hours in the day to perform necessary tasks.

The rules for additional help don’t usually make allowances for real life circumstances. If all members of a family of three have chronic illnesses, they may need more assistance.

What do you do if you need and don’t think you qualify for help? Where can you turn if placing your loved one in a nursing home isn’t a wise option?

The first place to turn is your Area Agency on Aging. The staff may know about resources in your area. You may not qualify for much, but a few hours of housekeeping and respite care are much better than none.

Next, spend some time searching your budget for ways to trim household spending. This may yield enough money to hire additional help for a few hours each week.

Though friends and family may be too busy to help with remaining tasks on a regular basis, most will have a few minutes or hours here and there. Keep a list of everyone who volunteers to help and what they are willing to do. Some may be able to help with specific tasks for short periods on a regular basis. Others will be willing to help during emergencies.

When people say they are willing to help, take them at their word. You’ll ruin your health if you try to do everything by yourself.

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Jacqueline Laurette Jones is author of Unmasking a Diagnosis: How to get Help for a Confusing Chronic Illness Without Filing for Bankruptcy.

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Request Skilled Therapy Before Leaving Hospital

January 15, 2009 By Jacqueline Laurette Jones Leave a Comment

Updated 1/16/09

If your loved one has been admitted to a hospital and needs skilled nursing therapy to regain some independence, make sure you inquire about it before you leave the hospital or soon afterward.

Medicare only allows admission to therapy within 30 days of a related hospital stay. There is no other legal way to receive this type of care through Medicare.

Though many people may tell you otherwise, there are two reasons why you shouldn’t try to fake an emergency to have your loved one readmitted to the hospital if your situation doesn’t fit within the rules. The first reason is you could be charged and convicted of Medicare fraud. The second is this country is in enough financial trouble right now without paying for unnecessary hospital bills. That money could be spent on care for your loved one.

If your situation falls outside the guidelines, pray about what to do next. You may also be able to find other options in your area if you call around.

To prevent facing this situation at all, make sure you read the latest Medicare rules if you haven’t already. Though keeping abreast of those rules may seem like an inconvenience, lack of understanding may someday hurt your loved one. It may also waste the government’s money and even more of your time and energy.

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Jacqueline Laurette Jones is author of Unmasking a Diagnosis: How to get Help for a Confusing Chronic Illness Without Filing for Bankruptcy.

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Blog Offers Thanks for Spotlight on Elder Abuse

October 21, 2008 By Jacqueline Laurette Jones 1 Comment

When I vented my frustrations in the post “Elder Law Can Interfere with Good Care,” I had no idea that the title highlighted a growing international controversy. The post was based on my observations of how the technicalities and costs of implementing our laws could lead to real trouble if not addressed.

In my follow up to that post, I shared a different view from Wendy H. Sheinberg, a Certified Elder Law Attorney (CELA) in Garden City, New York. She cited the Constitution, and she assured me that my statements “cast a scary shadow on laws that, for the most part, protect people.” Then a blog devoted to these issues praised my original post.

Spotlight on Elder Abuse posted the following statement:

“Thank you Jacqueline, for highlighting this important issue. There are so many cases of ‘Guardian/Conservator Abuse that needs to be addressed. But, we see very little been done. Imagine – we worked hard, paid our taxes; only to be abused by the system in our twilight years. Animals have more protection than many seniors. This is NOT acceptable in any language!”

I am glad to have played a part in shining a spotlight on this issue. Maybe I have more common sense than I think I have.

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Jacqueline Laurette Jones is author of Unmasking a Diagnosis: How to get Help for a Confusing Chronic Illness Without Filing for Bankruptcy.

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Never Assume Anyone Thinks Like You

October 17, 2008 By Jacqueline Laurette Jones 3 Comments

In yesterday’s post, I exhibited one of my greatest weaknesses. Because I would never deliberately hurt anyone, I usually assume the majority of people feel the same way. The results of my false assumptions could fill a book longer than War and Peace.

The current economic crisis should have been a wake up call for me. Instead, my frustrations with the complexities of caring for my parents overruled my common sense. Please forgive me, read to the end, and contact me with your own stories about dealing with these issues.

Wendy H. Sheinberg, a Certified Elder Law Attorney (CELA) in Garden City, New York, was kind enough to send an email that addressed specific points in my post. About Powers of Attorney, Ms. Sheinberg stated:

Your recent post misstated several facts and cast a scary shadow on laws that, for the most part, protect people. The state does not require the individual to execute these documents. The state has set up a structure that allows for the delegation of authority from the principal to the agent. This always existed as principal agency law and then became more specialized to allow particular delegations of very specific powers in a set way to insure a level of conformity which would then facilitate the use of these designations.

After rethinking my position on conservatorships, I was glad to read Ms. Sheinberg’s explanation of why limiting them won’t work:

The requirement of a guardian/conservator in the absence of such delegation is not found in an “elder law” but in the constitution, which is the very first law this country had. The constitution provides us with the right to be self determining and to address our own property. Such rights may not be infringed upon by anyone absent due process. Due process is a key component of any guardianship/ conservatorship as it limits personal liberties, including the restraining of property rights. These laws must exist. The inability to convey property or make medical decisions has always required capacity. Without capacity one cannot enter contracts, etc. The laws around the finding of a lack of capacity must follow constitutional guidelines, without which all of our freedoms would be at risk. This would result in allowing caregivers to determine on their own when they should be in charge and would infringe on the rights of the senior, without any due process and no oversight. I wonder what would be next on the firing range of constitutional infringement.

Though Ms. Sheinberg doesn’t explain how letting a home deteriorate from lack of use can help anyone, she cites a law that explains why my former neighbor’s home is vacant:

There is no seizure. Some states place a lien on the property to ensure a payback on death. The SCOTUS decision in Ahlbourne upheld the prohibition on the enforcement of liens until death. The lien is only in the amount of the service provided.

I stand behind my information on the requirement that a caregiver in my state live in a home two years before securing the right to remain there after the owner moves into a nursing home. This came straight from two CELAs.

Ms. Sheinberg explains another law that addresses the five year look back period:

DRA 2005, enacted as of 2/8/06, imposed a 5 year look back, which is fully enforced by 2009. This is a federal law. The states have the right to promulgate their own enforcement criteria, for DRA, but it is federal, and is technically required of all states accepting federal funds for Medicaid. Some states have been slower in their enforcement of the application of the new penalty rules, but there has been no hub bub about holding back on the five year look back. It is important for your readers to know that the five year look back and the new transfer rules only apply to transfers made after 2/6/08.

This still does not address the issue of paying for legal assistance to address these issues. Though there is no recognized “hub bub,” current economic realities prohibit many middle income families from getting help because the income guidelines are unrealistic.

This information may come too late to help some readers. Contact a Certified Elder Law Attorney in your state for personalized guidance. Visit the National Elder Law Foundation website to find a CELA near you.

Wendy H. Sheinberg, CELA, is a Partner in the law firm of Davidow, Davidow, Siegel & Stern, LLP, a law firm that concentrates in Special Needs, Elder Law, Estate Planning, Guardianships, Estate Administration Trusts, and Wills. She is one of fewer than 400 Certified Elder Law Attorneys. She has been certified by the National Elder Law Foundation as a Certified Elder Law Attorney and is one of fewer than 70 Fellows of the National Academy of Elder Law Attorneys and a member of its Board of Directors.

You can visit her firm’s website, email her at wsheinberg@davidowlaw.com, or call 516-393-0222.

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Jacqueline Laurette Jones is author of Unmasking a Diagnosis: How to get Help for a Confusing Chronic Illness Without Filing for Bankruptcy.

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Elder Law Can Interfere With Good Care

October 16, 2008 By Jacqueline Laurette Jones 3 Comments

Updated 10/17/08

After reading this post, click read “Never Assume Anyone Thinks Like You” for more information.

Elder law sometimes works against the interests of caregivers and patients. Laws that were designed to protect patients and the government from scam artists have become a nightmare for a number of people who only want to do what’s best for their loved ones.

Many states require that patients sign separate Powers of Attorney to designate whom they want to handle their health care and financial decisions if they become incapacitated. The laws in some states require that courts approve conservators to handle these tasks if Powers of Attorney are not available. Conservatorships in my state cost $10,000.

Elders who were born in a time when families automatically assumed care for their loved ones may not be aware of the requirements until it’s too late. Limited finances may keep caregivers from going to court, and their loved ones could suffer as a result. Caregivers should only be forced into court proceedings in cases of obvious abuse. Policy makers should also adjust income levels for free or discount legal services to reflect today’s realities.

Another policy allows officials to seize the home of a patient who has been admitted to a nursing home if the expenditures for care exceed the patient’s income. In some states, those who transfer assets to qualify for Medicaid must do so five years before nursing home admission or lose their home.

To avoid seizure of the property until after they die or move, caregivers must live with the patient and play a part in delaying his or her admission into the nursing home for at least two years. Many caregivers ruin their own health by continuing to provide care in a desperate attempt to avoid losing what has become their only home. Some have been forced into homelessness after giving up because they couldn’t handle the stress or because the patient died too soon.

Why should officials take property they can’t use when someone needs it? A former neighbor of ours in another town lost her home when she was admitted to a nursing home. The vacant structure now serves as a haven for drug addicts.

As a current or potential giver or recipient of care, these laws could affect you someday. Contact your state and national representatives to demand that health care reform address these issues, the ones I addressed in my last post, and any other concerns you may have.

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Jacqueline Laurette Jones is author of Unmasking a Diagnosis: How to get Help for a Confusing Chronic Illness Without Filing for Bankruptcy.

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Radical Change Can Save Medicare, Medicaid

October 9, 2008 By Jacqueline Laurette Jones 1 Comment

Updated 10/17/08

The next president of the United States must address the challenge of trimming Medicare and Medicaid costs. The vast baby boom generation has just begun to require services. Young and old citizens alike are succumbing to chronic diseases that can require years of expensive treatments. Many enter the system years ahead of schedule because of partial or total disability.

As a person living with and caring for someone with chronic illnesses, I want to share the following strategies that could greatly reduce the costs associated with these and related programs.

Redistribute a large portion of the funds now set aside for nursing home care into agencies that provide home care, day care, and respite services. The current regulations are absurd. Many caregivers provide full-time care for their loved ones because they can’t afford to send them to nursing homes or because most nursing homes have such bad reputations. The stress of attending to someone around the clock can lead to disability, premature death, or an illness that requires both the caregiver and patient to be admitted to a nursing home, in spite of the caregiver’s heroic efforts.

In addition to the in-home medical care and health education now provided, caregivers need help with bathing their patients two to three times a week and cleaning their homes once a week. Sitters and overnight respite care should be available as necessary. If based on individual family circumstances and guided by practical regulations, these services could help to reduce the number and length of nursing home admissions and create new jobs.

Require certification of non-medical home care agencies and training for their personnel. The pay is often so low that many of the workers don’t take their jobs seriously. Requiring certification and training would justify higher fees and wages and attract more responsible individuals into these positions.

Simplify paperwork for medical professionals. The amount of required documentation increases the cost of medical care and frustrates providers. The number of providers who will accept new Medicare patients in my city shrinks almost every month.

Reimburse non-traditional services provided by practitioners of functional medicine (FM). Unlike mainstream or allopathic medicine, functional or systems medicine addresses the causes of disease. FM practitioners focus on prevention as well as treatment of chronic diseases.

Give enough in food stamps to cover the cost of nutritious meals. Malnutrition leads to disease. Most people I know who are on food stamps run out of food long before the end of each month. A friend of mine, who is disabled, receives $10 a month. That won’t buy enough food to keep a cat healthy.

Ask recipients and providers how to improve these programs. Participants understand the weaknesses and strengths of the system.

For more on elder care issues, read my next three posts, “Elder Law Can Interfere with Good Care,” “Never Assume Anyone Thinks Like You,” and “Blog Offers Thanks for Spotlight on Elder Abuse.”

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Jacqueline L. Jones is author of Unmasking a Diagnosis: How to get Help for a Confusing Chronic Illness Without Filing for Bankruptcy. The book is available through Lulu.com and soon will be available through Amazon.com and other online book retailers.

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Who Will Care for the Living?

September 16, 2008 By Jacqueline Laurette Jones 1 Comment

My friend answered the phone immediately when I called. She was on her second visit to help another friend of hers, and that friend needed emergency prayers from everyone I could reach.

The recipient of these prayers had been caring for her mother around the clock for two years and had needed a break. The mother died shortly after my friend arrived this second time to help, but the next crisis had already begun.

Because the caregiver had been unable to work and tend to her mother at the same time, she and her mother had been living on the elder’s income. The long hours had taken their toll on the caregiver’s health, and she was unable to return to the job market. Soon insurance polices and other temporary income would be gone. She needed to sell everything, including the house, in order to survive. Suicide seemed like the only answer.

The prayers worked. The woman realized she needed to trust God, but sometimes more tangible help is needed. God often works through people. My friend, who is disabled and living on disability payments, could only help so much.

This woman is just one of countless citizens in this country who can’t see their way past the next moment. When added to other personal struggles, the tight job market, increasing energy and food prices, higher health care costs, and falling home prices are more than they can handle alone. They need prayers and encouragement, but they may need a helping hand. Traditional channels of aid are overwhelmed and nearly exhausted. People who gave in previous years now need help.

Five people I knew or who were related to people I know have committed suicide within the last two to three years. Four of these ended their lives within four weeks about two months ago.

This society has become so competitive it values productivity more than compassion. During each economic crisis, the cry goes out to cut entitlement programs. The politicians who lead these cries don’t understand that human lives are at stake. As they seek more ways to reward those who “win,” the “losers” are often left behind to drown in their own sweat and tears.

Though some abuses have occurred in the system, what do we have to gain as a country by turning our backs on the weakest in our society? How can we sleep at night while the elderly, the weak and the despondent are being pushed to the side, and sometimes over the edge?

Everyone needs help at times. If we are indeed “one nation under God” as we claim, why can’t we expend at least as much energy protecting those who have left the womb as we do on those who remain? How can we spend so much time fighting about preserving life when we spend so much money on taking it?

Who will care for the living? I tremble and shake my head as I begin to cry.

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Jacqueline L. Jones is author of Unmasking a Diagnosis: How to get Help for a Confusing Chronic Illness Without Filing for Bankruptcy. The book is available through Lulu.com and will be available early next year through Amazon.com and other online book retailers.

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Seek Help with Caregiving Duties (Part 3)

December 13, 2007 By Jacqueline Laurette Jones Leave a Comment

Friends, relatives, neighbors, and people in your local congregation of faith can be a great source of help with caregiving. As I stated in an earlier post, my friends and the few family members in the area are unable to help much. A member of my church recently volunteered to fill in the gap. What a difference her help made!

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Seek Help with Caregiving Duties (Part 2)

December 7, 2007 By Jacqueline Laurette Jones Leave a Comment

The next stop in the search for no- or low-cost help with caregiving is your Area Agency on Aging (AAA). They have the most comprehensive knowledge of resources for elder care, and they often provide services as well.

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Seek Help With Caregiving Duties (Part 1)

November 29, 2007 By Jacqueline Laurette Jones 3 Comments

I’m not into crowds. Most of my activities the last few years have centered around my home, parents, friends, and church, and I like it that way. But the responsibilities of caregiving have forced me to expand my circle by necessity.

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